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
StateLicense IDTaxonomies
NE2419261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy