Provider Demographics
NPI:1801470125
Name:HABRON-WACH, MAISIE GRACE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAISIE
Middle Name:GRACE
Last Name:HABRON-WACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-2913
Mailing Address - Country:US
Mailing Address - Phone:402-350-7427
Mailing Address - Fax:
Practice Address - Street 1:6101 S 56TH ST STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3392
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist