Provider Demographics
NPI:1992912414
Name:MID-NEBRASKA PHYSICAL THERAPY & SPORTS CENTER, P.C.
Entity type:Organization
Organization Name:MID-NEBRASKA PHYSICAL THERAPY & SPORTS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:308-534-0999
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-0747
Mailing Address - Country:US
Mailing Address - Phone:308-534-0999
Mailing Address - Fax:308-534-7299
Practice Address - Street 1:120 WEST LEOTA
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6036
Practice Address - Country:US
Practice Address - Phone:308-534-0999
Practice Address - Fax:308-534-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-11-26
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
NEX62299Medicare UPIN
NE099056Medicare PIN
NEX62299Medicare UPIN
NE=========32Medicaid