Stodden Physical Therapy,LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

1604 Issued in NE

Legal business name

STODDEN PHYSICAL THERAPY,LLC

Practice address

11532 Willow Park Dr
Su 100
Gretna, NE 68028-6947

Phone

(402) 289-5013

Fax

(402) 289-5018

NPI assigned

Mar 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mike Stodden, PT

Title

President

Phone

(402) 289-5013

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Stodden Physical Therapyllc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Stodden Physcial Therapy,L.L.C.

  • Physical Therapist
  • Bennington, NE
  • NPI 1063867984
  NPD tax ID
• Stodden Physical Therapy,LLC

  • Physical Therapist
  • Elkhorn, NE
  • NPI 1336104413
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Consbruck, DPT

  • Physical Therapist
  • Gretna, NE
  • NPI 1174589121
  NPD (past)
• Dustin Allen Huinker, DPT

  • Sports Physical Therapist
  • Elkhorn, NE
  • NPI 1811137359
  NPD (past)
• Shelley Lynn Vanackeren

  • Physical Therapy Assistant
  • Elkhorn, NE
  • NPI 1699915165
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1013031285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 N 205TH ST STODDEN PHYSICAL THERAPY,LLC",
            "address_2": "SU 140",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680224740",
            "telephone_number": "402-289-5013",
            "fax_number": "402-289-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11532 WILLOW PARK DR",
            "address_2": "SU 100",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680286947",
            "telephone_number": "402-289-5013",
            "fax_number": "402-289-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STODDEN PHYSICAL THERAPY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "STODDEN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-289-5013",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NE",
            "license": "1604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025488800",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "39960",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "216813",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Stauffer, D.C.
• Anna Clare Stednitz, BA
• Desiree Stednitz
• Lydia Starr Stednitz
• Jesseca Stockman
• Stacy Stohs, MS CF-SLP
• Kaitlyn Stukenholtz
• Fredrik Teeples
• Rei Teso
• The Wellness Place PC

• Specialist in Gretna, NE
• Providers in Gretna, NE by specialty
• Specialist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.