Provider Demographics
NPI:1982884102
Name:WHOLISTIC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:WHOLISTIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DZINGLE-NIEMOTH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:402-744-2000
Mailing Address - Street 1:240 W 94TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-1975
Mailing Address - Country:US
Mailing Address - Phone:402-744-2000
Mailing Address - Fax:
Practice Address - Street 1:240 W 94TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-1975
Practice Address - Country:US
Practice Address - Phone:402-744-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2468225100000X
NE1204225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02302OtherBCBSNE
NE10025372500Medicaid
NE02099OtherBCBSNE
NE10025372600Medicaid
NE=========68901A003OtherTRICARE