Activate PT LLC
Organization Active NPI Physical Therapist · Omaha, NE
NPI 1689315129 · NPPES record last updated Feb 7, 2023
Key facts
- NPI
- 1689315129
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- ACTIVATE PT LLC
- Practice address
- 9015 Arbor St Ste 155
Omaha, NE 68124-2072 - Phone
- (402) 580-1606
- NPI assigned
- Apr 6, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Nathaniel Allan Wissink, PT, DPT, MATCS
- Title
- Owner
- Phone
- (402) 580-1606
Practitioners 3
-
Nathaniel Allan Wissink, P.T., DPT, MATCS
-
Nicholas Robert Wissink, PT, DPT, MATCS,CSCS,
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220818000293 | NE | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 6608259015 |
Receives reassigned benefits from 2 practitioners Practice locations: Omaha, NE |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
9015 Arbor St Ste 155
Omaha, NE 68124-2072
Mailing address
9015 Arbor St Ste 155
Omaha, NE 68124-2072
Phone (531) 213-2666
Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.