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General NPI Number Information
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NPI Number | 1720543341
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Entity Type | Individual
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Provider Name | BRENNA PFAHLER MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 800 N COLUMBIA AVE
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City | SEWARD
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State | NE
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Zip | 68434
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Country | US
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Telephone | 402-643-7344
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Fax |
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Provider Business Mailing Address
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Address Line | 4630 LEIGHTON AVE APT 107A
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City | LINCOLN
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State | NE
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Zip | 68504-3609
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Country | US
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Telephone | 719-429-9037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2018022404
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1020
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License Number State | NE
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