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NPI Code Detail

MEDICARE: MRS. TAMMY L DVORAK PTA

MEDICARE: MRS. TAMMY L DVORAK PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant286NE

General Provider Information

NPI Number : 1558679985
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMMY L DVORAK PTA
Provider Business Mailing Address
First Line : 363 6TH RD
Second Line :
City : DODGE
State : NE
Zip : 68633-4017
Country : US
Telephone Number : 402-693-2571
Fax Number :
Provider Business Practice Location Address
First Line : 1120 WALNUT ST
Second Line :
City : NORTH BEND
State : NE
Zip : 68649-5012
Country : US
Telephone Number : 402-652-3242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2010
Last Update Date : 09/20/2010

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