Immanuel Dangerfield, DPT
Individual provider Active NPI Physical Therapist · Elkhorn, NE
NPI 1629957485 · NPPES record last updated Aug 27, 2025
Key facts
- NPI
- 1629957485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 308466 (CA)
- Practice address
- 18881 W Dodge Rd Ste 300W
Elkhorn, NE 68022-4648 - Phone
- (877) 230-3885
- NPI assigned
- Aug 27, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 308466 | CA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 308466 | CA | Yes |
Addresses
Primary practice location
18881 W Dodge Rd Ste 300W
Elkhorn, NE 68022-4648
Mailing address
8438 Alberton PL
Elk Grove, CA 95624-4071
Phone (916) 897-9748
Other practice location 1
690 Industrial Rd
San Carlos, CA 94070-3318
Phone (650) 592-6682
Other providers in Elkhorn, NE
- Kristen Pierrette Crownover
- CSL Elkhorn, LLC
- Elizabeth A Cullen
- Barbara A Dahl
- Joshua D Dahlke
- Vishakha P Darji
- Katilyn M Davenport
- Jennifer Ann Davey
- Kurt A Davey
- Jordan N Davis
All providers in Elkhorn, NE · Physical Therapist in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.