Provider Demographics
NPI:1679783963
Name:LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Entity type:Organization
Organization Name:LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHMHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-421-2700
Mailing Address - Street 1:1501 PINE LAKE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3692
Mailing Address - Country:US
Mailing Address - Phone:402-421-2700
Mailing Address - Fax:402-421-2699
Practice Address - Street 1:1501 PINE LAKE RD
Practice Address - Street 2:SUITE 20
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3692
Practice Address - Country:US
Practice Address - Phone:402-421-2700
Practice Address - Fax:402-421-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE0562490001Medicare NSC
NE091028Medicare PIN