Provider Demographics
NPI:1487940698
Name:VALENTINE PHYSICAL THERAPY AND SPORTS REHAB, LLC.
Entity type:Organization
Organization Name:VALENTINE PHYSICAL THERAPY AND SPORTS REHAB, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LANELL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-340-6501
Mailing Address - Street 1:130 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1830
Mailing Address - Country:US
Mailing Address - Phone:402-376-1140
Mailing Address - Fax:402-376-1140
Practice Address - Street 1:130 W 4TH ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1830
Practice Address - Country:US
Practice Address - Phone:402-376-1140
Practice Address - Fax:402-376-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2861261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026179000Medicaid