Provider Demographics
NPI:1073539987
Name:TESSENDORF, ROSS M (DPT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:M
Last Name:TESSENDORF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2791
Mailing Address - Country:US
Mailing Address - Phone:402-690-0411
Mailing Address - Fax:
Practice Address - Street 1:2123 E 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2498
Practice Address - Country:US
Practice Address - Phone:402-721-1112
Practice Address - Fax:402-721-1113
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist