Provider Demographics
NPI:1023019544
Name:LIEBIG, THADDEUS R (PT, DPT,ATC)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:R
Last Name:LIEBIG
Suffix:
Gender:M
Credentials:PT, DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W DARLENE ST
Mailing Address - Street 2:PO BOX 107
Mailing Address - City:HARTINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68739-4510
Mailing Address - Country:US
Mailing Address - Phone:402-254-3985
Mailing Address - Fax:402-254-3963
Practice Address - Street 1:401 W DARLENE ST
Practice Address - Street 2:
Practice Address - City:HARTINGTON
Practice Address - State:NE
Practice Address - Zip Code:68739-4510
Practice Address - Country:US
Practice Address - Phone:402-254-3985
Practice Address - Fax:402-254-3963
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1065225100000X
NE1668208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5834080Medicaid
SD5834080Medicaid