Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1668 | NE |
N | 225100000X | Physical Therapist | 1065 | SD |
NPI | 1023019544 |
---|---|
Provider Name | Dr. Thaddeus R Liebig |
First Address | Hartington, NE 68739-4510 |
Second Address | Hartington, NE 68739-4510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 29/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5834080 | (05) | SD |