Provider Demographics
NPI:1063790558
Name:TILDEN PHYSICAL THERAPY
Entity type:Organization
Organization Name:TILDEN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-371-9707
Mailing Address - Street 1:109 EAST 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TILDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68781-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 EAST 2ND ST
Practice Address - Street 2:
Practice Address - City:TILDEN
Practice Address - State:NE
Practice Address - Zip Code:68781-0000
Practice Address - Country:US
Practice Address - Phone:402-368-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORFOLK PHYSICAL THERAPY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty