Provider Demographics
NPI:1023396751
Name:THIESEN, TAMARA M (PTA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:THIESEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:SCRIBNER
Mailing Address - State:NE
Mailing Address - Zip Code:68057-3116
Mailing Address - Country:US
Mailing Address - Phone:402-664-2389
Mailing Address - Fax:402-664-2399
Practice Address - Street 1:815 LOGAN ST
Practice Address - Street 2:
Practice Address - City:SCRIBNER
Practice Address - State:NE
Practice Address - Zip Code:68057-3116
Practice Address - Country:US
Practice Address - Phone:402-664-2389
Practice Address - Fax:402-664-2399
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant