1164013116 NPI number — KOHOUT PHYSICAL THERAPY, LLC

Table of content: MRS. KATHY NAYLOR PRENEVOST MSW (NPI 1396881694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164013116 NPI number — KOHOUT PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOHOUT PHYSICAL THERAPY, LLC
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:
1164013116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 S COUNTRY CLUB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68467-4009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-469-3634
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 E. 4TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-745-6399
Provider Business Practice Location Address Fax Number:
402-745-6388
Provider Enumeration Date:
02/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KOHOUT
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-469-3634

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025822500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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