Provider Demographics
NPI:1760423404
Name:DRUECKER, DOROTHY JANE (PT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JANE
Last Name:DRUECKER
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 1:407 BLACK HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3243
Mailing Address - Country:US
Mailing Address - Phone:308-762-6564
Mailing Address - Fax:308-762-3747
Practice Address - Street 1:407 BLACK HILLS AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3243
Practice Address - Country:US
Practice Address - Phone:308-762-6564
Practice Address - Fax:308-762-3747
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02015OtherBCBS OF NE
P00183034Medicare ID - Type UnspecifiedRR MEDICARE
278612Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER
Q35674Medicare UPIN