Individual
KASANDRA L LICKTEIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
410 E 22ND ST, FREMONT, NE 68025-2609
(402) 721-3908
(402) 721-4047
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3023
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47649
BLUE CROSS BLUE SHIELD
NE
01
—
P01003060
RAILROAD MEDICARE
NE
Enumeration date
07/25/2011
Last updated
06/21/2024
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