Provider Demographics
NPI:1699756254
Name:NEBBELING, DIRK HANS (PT)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:HANS
Last Name:NEBBELING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1000
Mailing Address - Country:US
Mailing Address - Phone:620-227-1371
Mailing Address - Fax:620-227-1208
Practice Address - Street 1:2020 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-1000
Practice Address - Country:US
Practice Address - Phone:620-227-1371
Practice Address - Fax:620-227-1208
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100351040AMedicaid
KS100351040AMedicaid
KS149126Medicare ID - Type Unspecified