1689702276 NPI number — ABLE THERAPY, INC.

Table of content: (NPI 1689702276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689702276 NPI number — ABLE THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABLE THERAPY, INC.
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:
1689702276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2916 S 132ND ST
Provider Second Line Business Mailing Address:
#122
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68144-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-480-4819
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11912 ELM ST
Provider Second Line Business Practice Location Address:
#117
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68144-4443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-480-4819
Provider Business Practice Location Address Fax Number:
402-763-9435
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRADLEY
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OUTPATIENT THERAPIST
Authorized Official Telephone Number:
402-480-4819

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2978 , 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: 10025338700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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