Organization
ACTIVE SPINE PHYSICAL THERAPY, LLC
Active
Other names
Active Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS CHRISTOPHER MUCHOWICZ (PT)
(402) 932-2888
Entity
Organization
Contact information
Practice address
10110 NICHOLAS ST STE 100, OMAHA, NE 68114
(402) 932-2888
(402) 932-2899
Mailing address
10110 NICHOLAS ST STE 100, OMAHA, NE 68114-2185
(402) 932-2888
(402) 932-2899
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3643
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3643
STATE LICENSE
NE
05
—
3643
—
NE
Enumeration date
10/07/2016
Last updated
12/03/2018
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