Healthcare Provider Details

I. General information

NPI: 1669382115
Provider Name (Legal Business Name): TARYN DIMMITT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 W MAPLE RD STE 116
OMAHA NE
68164-6231
US

IV. Provider business mailing address

1317 N 113TH CT APT 6028
OMAHA NE
68154-5852
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5022
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: