Active NPI
Mirella A Gatterdam, DPT
- Pediatric Physical Therapist
- Elkhorn, NE
National Provider Identifier
1053247684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 4979
- Practice address
- 20502 Roosevelt St
Elkhorn, NE 68022-4148 - Phone
- (402) 955-8000
- Fax
- (402) 955-8001
- NPI assigned
- Jun 22, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 4979 | NE | Primary |
Addresses
Primary practice location
20502 Roosevelt St
Elkhorn, NE 68022-4148
Mailing address
PO Box 24607
Omaha, NE 68124-0607
Phone (402) 955-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nebraska Pediatric Practice, Inc | Past | Accepting new patients | |
| Children'S Specialty Physician Billing | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Nurse Practitioner
- Omaha, NE
- NPI 1013040369
-
- Pediatrics Physician
- Omaha, NE
- NPI 1144556333
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1782086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782172800000",
"number": "1053247684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 24607",
"city": "OMAHA",
"state": "NE",
"postal_code": "681240607",
"telephone_number": "402-955-5400",
"fax_number": "402-955-3674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20502 ROOSEVELT ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680224148",
"telephone_number": "402-955-8000",
"fax_number": "402-955-8001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATTERDAM",
"first_name": "MIRELLA",
"middle_name": "A",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-22",
"last_updated": "2026-06-23",
"certification_date": "2026-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NE",
"license": "4979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhorn, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.