Provider Demographics
NPI: | 1952605222 |
---|---|
Name: | PEARSON PHYSICAL THERAPY, PC |
Entity Type: | Organization |
Organization Name: | PEARSON PHYSICAL THERAPY, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | BECKY |
Authorized Official - Middle Name: | JEAN |
Authorized Official - Last Name: | PEARSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 308-872-5800 |
Mailing Address - Street 1: | 748 N 10TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BROKEN BOW |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68822-1224 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 308-872-5800 |
Mailing Address - Fax: | 308-872-5803 |
Practice Address - Street 1: | 748 N 10TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | BROKEN BOW |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68822-1224 |
Practice Address - Country: | US |
Practice Address - Phone: | 308-872-5800 |
Practice Address - Fax: | 308-872-5803 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-12-30 |
Last Update Date: | 2010-12-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 2419 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |