Provider Demographics
NPI:1558679985
Name:DVORAK, TAMMY L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:DVORAK
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 1:363 6TH RD
Mailing Address - Street 2:
Mailing Address - City:DODGE
Mailing Address - State:NE
Mailing Address - Zip Code:68633-4017
Mailing Address - Country:US
Mailing Address - Phone:402-693-2571
Mailing Address - Fax:
Practice Address - Street 1:1120 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-5012
Practice Address - Country:US
Practice Address - Phone:402-652-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE286225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant