Basic Information
| Provider Information | |||||||||
| NPI: | 1376864074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROKERING | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MATTA | ||||||||
| OtherFirstName: | DOROTHY | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8055 O ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685102564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024210904 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 575 S 70TH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685102471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022197495 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2010 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2848 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.