Provider Demographics
NPI:1902577992
Name:HEARTLAND NEUROLOGICAL THERAPY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HEARTLAND NEUROLOGICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHEROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:M PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-319-0801
Mailing Address - Street 1:1611 N 214TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-1612
Mailing Address - Country:US
Mailing Address - Phone:402-319-0801
Mailing Address - Fax:
Practice Address - Street 1:2650 RIVER ROAD DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-2040
Practice Address - Country:US
Practice Address - Phone:402-319-0801
Practice Address - Fax:402-769-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty