Organization
ACTIVE SPINE PHYSICAL THERAPY, LLC
Active
Other names
Active Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS CHRISTOPHER MUCHOWICZ PT (OWNER)
(402) 932-2888
Entity
Organization
Contact information
Practice address
11810 NICHOLAS ST STE 103, OMAHA, NE 68154-4453
(402) 932-2888
(402) 932-2899
Mailing address
11810 NICHOLAS ST STE 103, OMAHA, NE 68154-4453
(402) 932-2888
(402) 932-2899
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026165702
—
NE
05
—
107512
—
IA
Enumeration date
02/22/2012
Last updated
07/06/2021
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