Provider Demographics
NPI:1386776078
Name:EXSTROM PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:EXSTROM PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:EXSTROM LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-488-4282
Mailing Address - Street 1:3818 NORMAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-488-4282
Mailing Address - Fax:402-488-6157
Practice Address - Street 1:3818 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-488-4282
Practice Address - Fax:402-488-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100249565-00Medicaid
NE10024956500Medicaid
NE10024956500Medicaid