1053531756 NPI number — SANDHILLS PHYSICAL THERAPY AND SPORTS REHAB P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053531756 NPI number — SANDHILLS PHYSICAL THERAPY AND SPORTS REHAB P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILLS PHYSICAL THERAPY AND SPORTS REHAB P.C.
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:
Provider Other Organization Name Type Code:
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:
1053531756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 W LEOTA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69101-6532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-534-5590
Provider Business Mailing Address Fax Number:
308-534-5570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 W LEOTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-6532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-534-5590
Provider Business Practice Location Address Fax Number:
308-534-5570
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WENBURG
Authorized Official First Name:
AARON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PART OWNER/ PT
Authorized Official Telephone Number:
308-534-5590

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , 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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