1447580006 NPI number — MCMY PT CORP

Table of content: (NPI 1447580006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447580006 NPI number — MCMY PT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCMY PT CORP
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:
6
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:
1447580006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9515 PINE CREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIR
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68008-6580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-216-9329
Provider Business Mailing Address Fax Number:
402-933-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2835 N NEBRASKA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68467-8096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-362-2929
Provider Business Practice Location Address Fax Number:
402-362-3133
Provider Enumeration Date:
01/05/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCABE
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
402-216-9329

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2017 , 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)