Provider Demographics
NPI:1851681951
Name:BURESH, TIMOTHY L (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:BURESH
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 1:10060 REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3732
Mailing Address - Country:US
Mailing Address - Phone:402-354-1490
Mailing Address - Fax:402-354-1495
Practice Address - Street 1:10060 REGENCY CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3732
Practice Address - Country:US
Practice Address - Phone:402-354-1490
Practice Address - Fax:402-354-1495
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025896100Medicaid
NE10026056700Medicaid
NE10025941700Medicaid
NE10026252200Medicaid
NE10025895900Medicaid
NE10025896000Medicaid
IA1851681951Medicaid
NE10025896000Medicaid