Organization Active NPI

Wellspring Physical Therapy PC

  • Physical Therapist
  • Omaha, NE
National Provider Identifier
1013056944
Registry record updated May 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
WELLSPRING PHYSICAL THERAPY PC
Practice address
17055 Frances St
#102
Omaha, NE 68130-4655
Phone
(402) 934-9711
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2011

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

Authorized official

Name
Ms. Lauren M Potach, P.T.
Title
Physical Therapist
Phone
(402) 934-9711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

17055 Frances St
#102
Omaha, NE 68130-4655

Mailing address

17055 Frances St
#102
Omaha, NE 68130-4655
Phone (402) 934-9711

Other identifiers 1

IdentifierTypeStateIssuer
10025266100MedicaidNE

National Provider Directory

National Provider Directory

Locations

2920 N 118th St
Ste 105
Omaha, NE 68164
Phone (402) 934-9711

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306800000000",
    "number": "1013056944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17055 FRANCES ST",
            "address_2": "#102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304655",
            "telephone_number": "402-934-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17055 FRANCES ST",
            "address_2": "#102",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304655",
            "telephone_number": "402-934-9711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2011-05-31",
        "status": "A",
        "authorized_official_last_name": "POTACH",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "402-934-9711",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025266100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; 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.