1245646686 NPI number — SARA ELIZABETH PALINSKI PT, DPT

Table of content: SARA ELIZABETH PALINSKI PT, DPT (NPI 1245646686)

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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