1326551532 NPI number — FAMILY PHYSICAL THERAPY & SPORTS CENTER

Table of content: (NPI 1326551532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326551532 NPI number — FAMILY PHYSICAL THERAPY & SPORTS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHYSICAL THERAPY & SPORTS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY PHYSICAL THERAPY AND CHIROPRACTIC SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326551532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 W 33RD ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68845-3485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-452-7154
Provider Business Mailing Address Fax Number:
308-452-3394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 E 25TH ST STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-455-1781
Provider Business Practice Location Address Fax Number:
308-455-1782
Provider Enumeration Date:
11/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FIDDELKE
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
308-452-7154

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1928 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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