Provider Demographics
NPI:1730144726
Name:BERTHELSEN, BRIAN TIMOTHY (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:BERTHELSEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 S 123RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2735
Mailing Address - Country:US
Mailing Address - Phone:402-333-5305
Mailing Address - Fax:
Practice Address - Street 1:2220 S 123RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2735
Practice Address - Country:US
Practice Address - Phone:402-333-5305
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer