Provider Demographics
NPI:1952562027
Name:NINEMIRE, TARYN A (DPT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:A
Last Name:NINEMIRE
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 1:9370 WESTERN AVE
Mailing Address - Street 2:#107
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-6750
Mailing Address - Country:US
Mailing Address - Phone:402-762-5118
Mailing Address - Fax:
Practice Address - Street 1:9370 WESTERN AVE
Practice Address - Street 2:#107
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-6750
Practice Address - Country:US
Practice Address - Phone:402-762-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39509OtherBLUE CROSS BLUE SHIELD
NE098958004Medicare PIN
NEP00727011OtherRAILROAD MEDICARE