Provider Demographics
NPI:1841207610
Name:THOMAS, TANNER LEE (DPT)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:2380 8TH AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2367
Practice Address - Country:US
Practice Address - Phone:402-296-3433
Practice Address - Fax:402-296-3531
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00378278OtherRR MEDICARE
39849OtherBCBS NE
280600Medicare PIN