Provider Demographics
NPI:1588822761
Name:FLYNN, THOMAS KELLY (DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:KELLY
Last Name:FLYNN
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 1:2403 S 133RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5905
Mailing Address - Country:US
Mailing Address - Phone:402-330-8433
Mailing Address - Fax:402-330-8616
Practice Address - Street 1:301 W BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9071
Practice Address - Country:US
Practice Address - Phone:712-322-9688
Practice Address - Fax:712-322-1299
Is Sole Proprietor?:No
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4229225100000X
NE2639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist