Organization
STODDEN PHYSICAL THERAPY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE J STODDEN PT (PRESIDENT & OWNER)
(402) 289-5013
Entity
Organization
Contact information
Practice address
1405 N 205TH ST, SUITE 140, ELKHORN, NE 68022-4740
(402) 289-5013
(402) 289-5018
Mailing address
1405 N 205TH ST, SUITE 140, ELKHORN, NE 68022-4740
(402) 289-5013
(402) 289-5018
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025112300
—
NE
01
—
216813
COVENTRY
—
01
—
39960
BCBS
—
Enumeration date
04/20/2006
Last updated
05/31/2013
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