Provider Demographics
NPI:1982199394
Name:WARDEN, JOEL (DPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:WARDEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4683 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2031
Mailing Address - Country:US
Mailing Address - Phone:660-909-1675
Mailing Address - Fax:
Practice Address - Street 1:1001 FORT CROOK RD N STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4226
Practice Address - Country:US
Practice Address - Phone:402-763-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015755225100000X
TX1323881225100000X
WI14239-24261QP2000X
NE4256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty