Provider Demographics
NPI:1578650263
Name:STOOTSBERRY, THOMAS T
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:STOOTSBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 HAVELOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1328
Mailing Address - Country:US
Mailing Address - Phone:402-325-0044
Mailing Address - Fax:
Practice Address - Street 1:6319 HAVELOCK AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-1328
Practice Address - Country:US
Practice Address - Phone:402-325-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE650017454OtherRR MEDICARE
NE36523OtherBCBS
NE650017454OtherRR MEDICARE