Provider Demographics
NPI:1396917324
Name:SPECIALIZED PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:SPECIALIZED PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-981-1406
Mailing Address - Street 1:2728 N 108TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3763
Mailing Address - Country:US
Mailing Address - Phone:402-939-7939
Mailing Address - Fax:402-939-7940
Practice Address - Street 1:2728 N 108TH ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3763
Practice Address - Country:US
Practice Address - Phone:402-939-7939
Practice Address - Fax:402-939-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty