Provider Demographics
NPI:1740205103
Name:SIEGMUND, SUSAN ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SIEGMUND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:LOFGREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:5030 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3831
Mailing Address - Country:US
Mailing Address - Phone:402-659-4346
Mailing Address - Fax:402-551-3257
Practice Address - Street 1:5030 GROVER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3831
Practice Address - Country:US
Practice Address - Phone:402-659-4346
Practice Address - Fax:402-551-3257
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2446225100000X
IA03965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025229000Medicaid
NE099668Medicare PIN
NE10025229000Medicaid