Healthcare Provider Details

I. General information

NPI: 1780500942
Provider Name (Legal Business Name): TREV MUMM BSPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK AVE
HEBRON NE
68370-2019
US

IV. Provider business mailing address

120 PARK AVE
HEBRON NE
68370-2019
US

V. Phone/Fax

Practice location:
  • Phone: 402-768-4633
  • Fax: 402-768-4670
Mailing address:
  • Phone: 402-768-4633
  • Fax: 402-768-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1858
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: