Provider Demographics
NPI:1457513418
Name:OMAHA THERAPY DBA REHAB VISIONS
Entity Type:Organization
Organization Name:OMAHA THERAPY DBA REHAB VISIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-483-9400
Mailing Address - Street 1:683 STATE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:683 STATE AVE STE B
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4660
Practice Address - Country:US
Practice Address - Phone:701-483-9400
Practice Address - Fax:701-483-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52114Medicaid
ND12229OtherBCND
ND12229OtherBCND