Provider Demographics
NPI:1982266037
Name:THIEM, TRACI LEE (PTA)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:THIEM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LEE
Other - Last Name:ASCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1605 38 RD
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-6800
Mailing Address - Country:US
Mailing Address - Phone:402-326-1013
Mailing Address - Fax:
Practice Address - Street 1:624 PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1055
Practice Address - Country:US
Practice Address - Phone:402-643-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE950225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant