# NOLL SPINE REHABILITATION AND ORTHOPEDIC PHYSICAL THERAPY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063407518
- **Authorized official:** DR. ERIC P NOLL DPT, CERT MDT (PRESIDENT)
- **Authorized official phone:** (402) 991-7988

## Contact information

- **Practice address:** 11414 W CENTER RD, STE 242, OMAHA, NE 68144-4487
- **Practice address phone:** (402) 991-7988
- **Practice address fax:** (402) 933-2684
- **Mailing address:** 11414 W CENTER RD, STE 242, OMAHA, NE 68144-4487
- **Mailing address phone:** (402) 991-7988
- **Mailing address fax:** (402) 933-2684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 1870 | NE | Yes |

## Other

- **Enumeration date:** 09/12/2005
- **Last updated:** 05/03/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025099600 | — | NE |