Provider Demographics
NPI:1154607455
Name:TONJES, BRIANNA (PTA, LMT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:TONJES
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 640TH RD
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-5508
Mailing Address - Country:US
Mailing Address - Phone:402-922-0359
Mailing Address - Fax:
Practice Address - Street 1:318 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAY SPRINGS
Practice Address - State:NE
Practice Address - Zip Code:69347-1107
Practice Address - Country:US
Practice Address - Phone:308-638-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE801225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant