Active NPI
Kasandra L Lickteig, DPT
- Physical Therapist
- Fremont, NE
National Provider Identifier
1306124383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3023
- Practice address
- 410 E 22ND St
Fremont, NE 68025-2609 - Phone
- (402) 721-3908
- Fax
- (402) 721-4047
- NPI assigned
- Jul 25, 2011
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3023 | NE | Primary |
Addresses
Primary practice location
410 E 22ND St
Fremont, NE 68025-2609
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47649 | Other | NE | BLUE CROSS BLUE SHIELD |
| P01003060 | Other | NE | RAILROAD MEDICARE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3023 | NE | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718928000000",
"number": "1306124383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 E 22ND ST",
"city": "FREMONT",
"state": "NE",
"postal_code": "680252609",
"telephone_number": "402-721-3908",
"fax_number": "402-721-4047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICKTEIG",
"first_name": "KASANDRA",
"middle_name": "L",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-25",
"last_updated": "2024-06-21",
"certification_date": "2024-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NE",
"license": "3023",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "47649",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01003060",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.