Provider Demographics
NPI:1548884935
Name:NEBRASKA PELVIC THERAPY
Entity type:Organization
Organization Name:NEBRASKA PELVIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIERRA
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-618-3320
Mailing Address - Street 1:2510 S 140TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2339
Mailing Address - Country:US
Mailing Address - Phone:402-618-3320
Mailing Address - Fax:402-913-3102
Practice Address - Street 1:2510 S 140TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2339
Practice Address - Country:US
Practice Address - Phone:402-618-3320
Practice Address - Fax:402-913-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026857600Medicaid