1881830404 NPI number — MARIAN LORD, PHYSICAL THERAPIST, P.C.

Table of content: (NPI 1881830404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881830404 NPI number — MARIAN LORD, PHYSICAL THERAPIST, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIAN LORD, PHYSICAL THERAPIST, 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:
1881830404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14441 DUPONT CT
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68144-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-334-6213
Provider Business Mailing Address Fax Number:
402-334-6218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14441 DUPONT CT
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68144-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-334-6213
Provider Business Practice Location Address Fax Number:
402-334-6218
Provider Enumeration Date:
01/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LORD
Authorized Official First Name:
MARIAN
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-334-6213

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  712 , 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: 09205 . This is a "BLUE CROSS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: F247007 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: NA1244 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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