Provider Demographics
NPI:1134438872
Name:PU, LAN LIN (MPT)
Entity type:Individual
Prefix:
First Name:LAN LIN
Middle Name:
Last Name:PU
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 BLACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3138
Mailing Address - Country:US
Mailing Address - Phone:402-201-6689
Mailing Address - Fax:
Practice Address - Street 1:1625 BLACKBERRY DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3138
Practice Address - Country:US
Practice Address - Phone:402-201-6689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025895900Medicaid
NE10026056700Medicaid
NE10025896000Medicaid
NE099099086Medicare PIN
IA1134438872Medicaid
NE10025896100Medicaid
NE10025941700Medicaid
NE10026252200Medicaid