Provider Demographics
NPI:1881702884
Name:FREESE, MARLYS (PT)
Entity type:Individual
Prefix:
First Name:MARLYS
Middle Name:
Last Name:FREESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARLYS
Other - Middle Name:
Other - Last Name:DE GROOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4710 HAPPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5124
Mailing Address - Country:US
Mailing Address - Phone:402-416-6810
Mailing Address - Fax:
Practice Address - Street 1:4710 HAPPY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5124
Practice Address - Country:US
Practice Address - Phone:402-416-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00451686Medicare PIN
280467Medicare PIN
NE02184OtherBCBS