Provider Demographics
NPI:1104119007
Name:TESAREK, JOANN M (PTA)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:TESAREK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:M
Other - Last Name:THROENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1103 GALVIN RD S
Mailing Address - Street 2:AREA A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3004
Mailing Address - Country:US
Mailing Address - Phone:402-408-0890
Mailing Address - Fax:402-408-0891
Practice Address - Street 1:1103 GALVIN RD S
Practice Address - Street 2:AREA A
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3004
Practice Address - Country:US
Practice Address - Phone:402-408-0890
Practice Address - Fax:402-408-0891
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE295225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant