Organization
STODDEN PHYSICAL THERAPY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE STODDEN PT (PRESIDENT)
(402) 289-5013
Entity
Organization
Contact information
Practice address
11532 WILLOW PARK DR, SU 100, GRETNA, NE 68028-6947
(402) 289-5013
(402) 289-5018
Mailing address
1405 N 205TH ST STODDEN PHYSICAL THERAPY,LLC, SU 140, ELKHORN, NE 68022-4740
(402) 289-5013
(402) 289-5018
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1604
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025488800
—
NE
01
—
216813
COVENTRY
—
01
—
39960
BCBS
NE
Enumeration date
03/16/2007
Last updated
03/10/2015
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