Provider Demographics
NPI:1487763660
Name:BLOMENKAMP, SARAH T (DPT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:T
Last Name:BLOMENKAMP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:T
Other - Last Name:KUKUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3652
Mailing Address - Country:US
Mailing Address - Phone:402-682-4210
Mailing Address - Fax:402-682-4256
Practice Address - Street 1:1702 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3652
Practice Address - Country:US
Practice Address - Phone:402-682-4210
Practice Address - Fax:402-682-4256
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P65879Medicare UPIN
NE275849Medicare ID - Type Unspecified