Basic Information
Provider Information
NPI: 1487987228
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: SARA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BRUENING
OtherFirstName: SARA
OtherMiddleName: MARIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 985450 NEBRASKA MEDICAL CTR
Address2:  
City: OMAHA
State: NE
PostalCode: 681985450
CountryCode: US
TelephoneNumber: 4025596580
FaxNumber: 4025595737
Practice Location
Address1: 444 S 44TH ST
Address2:  
City: OMAHA
State: NE
PostalCode: 681313727
CountryCode: US
TelephoneNumber: 4025596580
FaxNumber: 4025595737
Other Information
ProviderEnumerationDate: 09/11/2009
LastUpdateDate: 09/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251P0200X2224NEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics

No ID Information.


Home