Provider Demographics
NPI:1780794909
Name:BARGSTADT-WILSON, KARI FAY (PT)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:FAY
Last Name:BARGSTADT-WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:FAY
Other - Last Name:BARGSTADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, WCS, CSCS
Mailing Address - Street 1:17055 FRANCES ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4655
Mailing Address - Country:US
Mailing Address - Phone:402-280-3555
Mailing Address - Fax:402-280-3557
Practice Address - Street 1:17055 FRANCES ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4655
Practice Address - Country:US
Practice Address - Phone:402-280-3555
Practice Address - Fax:402-280-3557
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist