Individual
PETER WIDHALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2900 F ST, OMAHA, NE 68107-1533
(402) 731-7990
Mailing address
3401 MARTHA ST APT 11E, OMAHA, NE 68105-3168
(631) 871-2593
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1184
NE
Other
Enumeration date
12/27/2017
Last updated
03/17/2018
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