Provider Demographics
NPI:1841673357
Name:TACKE, BRIAN FRANCIS (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:TACKE
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 1:418 S 38TH AVE
Mailing Address - Street 2:APT #21
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3849
Mailing Address - Country:US
Mailing Address - Phone:605-660-3916
Mailing Address - Fax:
Practice Address - Street 1:418 S 38TH AVE
Practice Address - Street 2:APT #21
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3849
Practice Address - Country:US
Practice Address - Phone:605-660-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist