Organization
PT WEST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY J MARLATT PT ATC (PRESIDENT)
(308) 282-0203
Entity
Organization
Contact information
Practice address
100 S MAIN, GORDON, NE 69343-1618
(308) 282-0203
(308) 282-1276
Mailing address
PO BOX 28, 100 SOUTH MAIN, GORDON, NE 69343-1618
(308) 282-0203
(308) 282-1276
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
651
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025453000
—
NE
01
—
39986
BLUE CROSS
NE
05
—
5831283
—
SD
Enumeration date
10/02/2006
Last updated
05/19/2008
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