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General NPI Number Information
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NPI Number | 1770122558
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Entity Type | Individual
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Provider Name | ELIZABETH L LABOMBARD MAED, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 16610 BENNINGTON RD
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City | BENNINGTON
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State | NE
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Zip | 68007-5552
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Country | US
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Telephone | 402-689-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E ALEXANDER ST
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City | VALLEY
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State | NE
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Zip | 68064-9728
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Country | US
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Telephone |
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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 | 701
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License Number State | NE
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