Provider Demographics
NPI:1699883652
Name:BEDNAR, BRENT R (MPT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:R
Last Name:BEDNAR
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 S 59TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6565
Mailing Address - Country:US
Mailing Address - Phone:402-540-6548
Mailing Address - Fax:
Practice Address - Street 1:4920 N 26TH ST
Practice Address - Street 2:STE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4748
Practice Address - Country:US
Practice Address - Phone:402-434-5361
Practice Address - Fax:402-434-5365
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist