Provider Demographics
NPI:1437453164
Name:NEBRASKA CITY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:NEBRASKA CITY PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-334-6027
Mailing Address - Street 1:1104 GRUNDMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-3397
Mailing Address - Country:US
Mailing Address - Phone:402-873-7411
Mailing Address - Fax:402-873-7413
Practice Address - Street 1:1104 GRUNDMAN BLVD
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-3397
Practice Address - Country:US
Practice Address - Phone:402-873-7411
Practice Address - Fax:402-873-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100258032-00Medicaid
NE100259310-00Medicaid
NE100259310-01Medicaid