Provider Demographics
NPI:1184890675
Name:THYGESEN PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:THYGESEN PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:THYGESEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-423-7878
Mailing Address - Street 1:5955 S 56TH ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3391
Mailing Address - Country:US
Mailing Address - Phone:402-423-7878
Mailing Address - Fax:402-423-0272
Practice Address - Street 1:5955 S 56TH ST
Practice Address - Street 2:SUITE ONE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025615300Medicaid
NENA1042Medicare PIN