1245646686 NPI number — SARA ELIZABETH PALINSKI PT, DPT

Table of content: MICHAEL LATRAE PETERSON (NPI 1548715634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245646686 NPI number — SARA ELIZABETH PALINSKI PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALINSKI
Provider First Name:
SARA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOEFFELHOLZ
Provider Other First Name:
SARA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245646686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 N 144TH AVE
Provider Second Line Business Mailing Address:
STE. 102
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-1935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-934-8688
Provider Business Mailing Address Fax Number:
402-934-8689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 N 144TH AVE
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-934-8688
Provider Business Practice Location Address Fax Number:
402-934-8689
Provider Enumeration Date:
07/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3346 , 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)

  • Identifier: 10025518800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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