Provider Demographics
NPI:1063867984
Name:STODDEN PHYSCIAL THERAPY,L.L.C.
Entity type:Organization
Organization Name:STODDEN PHYSCIAL THERAPY,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:STODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-289-5013
Mailing Address - Street 1:15767 C W HADAN DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-2015
Mailing Address - Country:US
Mailing Address - Phone:402-238-2552
Mailing Address - Fax:402-238-3662
Practice Address - Street 1:15767 C W HADAN DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-2015
Practice Address - Country:US
Practice Address - Phone:402-238-2552
Practice Address - Fax:402-238-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1604225100000X
NE2556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099709Medicare UPIN