Provider Demographics
NPI:1922059138
Name:FAIMON, TRICIA L (DPT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:FAIMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2473
Mailing Address - Country:US
Mailing Address - Phone:402-564-5456
Mailing Address - Fax:402-562-6350
Practice Address - Street 1:3211 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2473
Practice Address - Country:US
Practice Address - Phone:402-564-5456
Practice Address - Fax:402-562-6350
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082077300Medicaid
NE47082077300Medicaid