Healthcare Provider Details

I. General information

NPI: 1639636087
Provider Name (Legal Business Name): THOMAS MICHAEL BUEHLER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16940 LAKESIDE HILLS PLZ
OMAHA NE
68130-2431
US

IV. Provider business mailing address

15334 POLK CIR
OMAHA NE
68137-3858
US

V. Phone/Fax

Practice location:
  • Phone: 402-758-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: