Provider Demographics
NPI:1437225000
Name:PREMIER THERAPY ASSOCIATES, PC
Entity type:Organization
Organization Name:PREMIER THERAPY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-933-0100
Mailing Address - Street 1:1313 S SADDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2402
Mailing Address - Country:US
Mailing Address - Phone:402-933-0100
Mailing Address - Fax:402-933-0200
Practice Address - Street 1:1313 S SADDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2402
Practice Address - Country:US
Practice Address - Phone:402-933-0100
Practice Address - Fax:402-933-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025334600Medicaid
NE099721Medicare ID - Type Unspecified