Healthcare Provider Details

I. General information

NPI: 1487304879
Provider Name (Legal Business Name): GRACE KUGLER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 S 144TH ST
OMAHA NE
68144-5243
US

IV. Provider business mailing address

5612 WALNUT ST
OMAHA NE
68106-2263
US

V. Phone/Fax

Practice location:
  • Phone: 402-609-3000
  • Fax:
Mailing address:
  • Phone: 832-707-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: