Healthcare Provider Details

I. General information

NPI: 1104758366
Provider Name (Legal Business Name): MIKYA JO LIERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 3RD ST
WILBER NE
68465-3144
US

IV. Provider business mailing address

209 W 3RD ST
WILBER NE
68465-3144
US

V. Phone/Fax

Practice location:
  • Phone: 402-821-3320
  • Fax:
Mailing address:
  • Phone: 402-821-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2234
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: