Provider Demographics
NPI:1740262963
Name:OSTDIEK, DONALD PATRICK (DPT)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PATRICK
Last Name:OSTDIEK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3325
Mailing Address - Country:US
Mailing Address - Phone:402-614-8042
Mailing Address - Fax:402-614-8043
Practice Address - Street 1:3407 S 84TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3325
Practice Address - Country:US
Practice Address - Phone:402-614-8042
Practice Address - Fax:402-614-8043
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025878400Medicaid
NEP00892273OtherRAILROAD MEDICARE
NE39841OtherBLUE CROSS BLUE SHIELD
NENA1773001Medicare PIN