Provider Demographics
NPI:1730285180
Name:PHYSICAL THERAPY & SPORTS REHAB OF HASTINGS INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY & SPORTS REHAB OF HASTINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-8824
Mailing Address - Street 1:207 S BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5905
Mailing Address - Country:US
Mailing Address - Phone:402-462-8824
Mailing Address - Fax:402-462-8017
Practice Address - Street 1:207 S BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5905
Practice Address - Country:US
Practice Address - Phone:402-462-8824
Practice Address - Fax:402-462-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7537OtherBLUE CROSS
NE7537OtherBLUE CROSS
NE=========13Medicaid
NE=========69Medicaid
NE=========69Medicaid
=========OtherTRICARE
NE0543260001Medicare NSC