Provider Demographics
NPI:1710236492
Name:RIES, MAUREEN A (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:RIES
Suffix:
Gender:F
Credentials:PT
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 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:8901 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3327
Practice Address - Country:US
Practice Address - Phone:402-354-8980
Practice Address - Fax:402-354-8992
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025896000Medicaid
NE10025896100Medicaid
IA1710236492Medicaid
NE10025941700Medicaid
NE10026056700Medicaid
NE10026252200Medicaid
NE10025895900Medicaid
NE099099169Medicare PIN