Provider Demographics
NPI:1851452973
Name:THYGESEN, PAUL A (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:THYGESEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 S 56TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3391
Mailing Address - Country:US
Mailing Address - Phone:402-438-0058
Mailing Address - Fax:
Practice Address - Street 1:5955 S 56TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3391
Practice Address - Country:US
Practice Address - Phone:402-423-7878
Practice Address - Fax:402-423-0272
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025615300Medicaid
NENA1042001Medicare PIN