Provider Demographics
NPI:1891846572
Name:LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Entity Type:Organization
Organization Name:LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEMHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-2700
Mailing Address - Street 1:6940 VAN DORN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2858
Mailing Address - Country:US
Mailing Address - Phone:402-483-4709
Mailing Address - Fax:402-483-4097
Practice Address - Street 1:2550 SUPERIOR ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4155
Practice Address - Country:US
Practice Address - Phone:402-476-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE0773441DPC225100000X, 225100000X
NE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0562490001Medicare NSC
NE091028Medicare PIN
NE=========13Medicaid