Provider Demographics
NPI:1245849215
Name:LINE, KEVIN DUANE (DPT, ATC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DUANE
Last Name:LINE
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2473
Mailing Address - Country:US
Mailing Address - Phone:402-564-5456
Mailing Address - Fax:402-562-6350
Practice Address - Street 1:3211 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2473
Practice Address - Country:US
Practice Address - Phone:402-564-5456
Practice Address - Fax:402-562-6350
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4690225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty