Provider Demographics
NPI:1679855530
Name:PHILLIPS, TAMRA SUE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:SUE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34669
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0669
Mailing Address - Country:US
Mailing Address - Phone:402-932-6791
Mailing Address - Fax:402-614-7835
Practice Address - Street 1:11901 PACIFIC ST STE 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3421
Practice Address - Country:US
Practice Address - Phone:402-401-6151
Practice Address - Fax:402-401-6181
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist