Healthcare Provider Details

I. General information

NPI: 1740750389
Provider Name (Legal Business Name): BRETT SKOF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6607 SOUTH 108TH COURT #210
OMAHA NE
68137
US

IV. Provider business mailing address

6607 SOUTH 108TH COURT #210
OMAHA NE
68137
US

V. Phone/Fax

Practice location:
  • Phone: 612-214-5572
  • 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: