MEDICARE: TANNER LEE THOMAS DPT

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
1	225100000X	Physical Therapist	2485	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00378278	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	39849	OTHER		BCBS NE

General Provider Information

NPI Number	:	1841207610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNER LEE THOMAS DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	2380 8TH AVE
Second Line	:	SUITE 8
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-2367
Country	:	US
Telephone Number	:	402-296-3433
Fax Number	:	402-296-3531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	06/25/2016

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Directions to “ TANNER LEE THOMAS DPT” Practice Location

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