Organization
CRETE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE BLACKMON (ADMINISTRATOR)
(770) 748-0309
Entity
Organization
Contact information
Practice address
830 E 1ST ST, CRETE, NE 68333-3108
(402) 826-2255
(402) 826-2288
Mailing address
PO BOX 294, CRETE, NE 68333-0294
(402) 826-2255
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025366000
—
NE
05
—
10025366002
—
NE
Enumeration date
05/26/2006
Last updated
08/18/2021
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