Provider Demographics
NPI:1356373658
Name:FAMILY PHYSICAL THERAPY & SPORTS CENTER
Entity type:Organization
Organization Name:FAMILY PHYSICAL THERAPY & SPORTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-236-5884
Mailing Address - Street 1:211 W 33RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3456
Mailing Address - Country:US
Mailing Address - Phone:308-236-5884
Mailing Address - Fax:308-236-9621
Practice Address - Street 1:211 W 33RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3456
Practice Address - Country:US
Practice Address - Phone:308-236-5884
Practice Address - Fax:308-236-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6195080001Medicare NSC