Provider Demographics
NPI:1972198505
Name:BETTENHAUSEN, JUSTICE RAE
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:RAE
Last Name:BETTENHAUSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 1ST RD
Mailing Address - Street 2:
Mailing Address - City:HOWELLS
Mailing Address - State:NE
Mailing Address - Zip Code:68641-4013
Mailing Address - Country:US
Mailing Address - Phone:402-380-0299
Mailing Address - Fax:
Practice Address - Street 1:4715 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1622
Practice Address - Country:US
Practice Address - Phone:402-942-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1907208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation