Provider Demographics
NPI:1922081389
Name:VANDERHEIDEN, GINA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:VANDERHEIDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:KRUMLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:114 E 1ST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2405
Mailing Address - Country:US
Mailing Address - Phone:402-933-2010
Mailing Address - Fax:402-933-3050
Practice Address - Street 1:114 E 1ST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2405
Practice Address - Country:US
Practice Address - Phone:402-933-2010
Practice Address - Fax:402-933-3050
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277113Medicare ID - Type UnspecifiedMEDICARE NUMBER
NEQ03829Medicare UPIN
IA0599217Medicaid
NE39895OtherBLUE CROSS BLUE SHIELD
NEP00116567Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER