Provider Demographics
NPI:1295910248
Name:CLAY COUNTY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:CLAY COUNTY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-773-0270
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:NE
Mailing Address - Zip Code:68979-0465
Mailing Address - Country:US
Mailing Address - Phone:402-773-0270
Mailing Address - Fax:402-773-0272
Practice Address - Street 1:117 S SAUNDERS AVE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:NE
Practice Address - Zip Code:68979-2051
Practice Address - Country:US
Practice Address - Phone:402-773-0270
Practice Address - Fax:402-773-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025579800Medicaid
NE900066Medicare PIN