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General NPI Number Information
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NPI Number | 1851804041
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Entity Type | Individual
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Provider Name | THOMAS KENNETH KSIAZEK MSAT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1115 S COTTONWOOD ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6108
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Country | US
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Telephone | 308-568-7456
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Fax |
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Provider Business Mailing Address
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Address Line | 816 S YORK AVE
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6279
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Country | US
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Telephone | 402-276-6590
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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 | 854
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License Number State | NE
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