Provider Demographics
NPI:1568400166
Name:BENES, TARA R (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:R
Last Name:BENES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:R
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 TIGER LILY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5587
Mailing Address - Country:US
Mailing Address - Phone:402-420-7000
Mailing Address - Fax:402-420-6969
Practice Address - Street 1:4101 TIGER LILY RD STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5587
Practice Address - Country:US
Practice Address - Phone:402-420-7000
Practice Address - Fax:402-420-6969
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2113225100000X
PAPT017675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097781F8RMedicare PIN