Individual
MS. THERESA STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2525 S 135TH AVE, OMAHA, NE 68144-2424
(402) 333-2304
Mailing address
11606 DAVENPORT PLZ APT 15, OMAHA, NE 68154-2548
(402) 613-3048
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1658
NE
Other
Enumeration date
03/03/2018
Last updated
03/03/2018
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