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Individual

MARY JANE THEILER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
410 E 22ND ST, FREMONT, NE 68025-2609
(402) 721-3908
(402) 721-4047
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1155
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0586347
IA
01
6531
BLUE CROSS BLUE SHIELD
NE
Enumeration date
11/14/2005
Last updated
06/25/2016
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