Provider Demographics
NPI:1013576818
Name:CYBORON, TRACY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:NICOLE
Last Name:CYBORON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:WISNER
Mailing Address - State:NE
Mailing Address - Zip Code:68791
Mailing Address - Country:US
Mailing Address - Phone:308-216-1204
Mailing Address - Fax:
Practice Address - Street 1:3200 RAASCH DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3455
Practice Address - Country:US
Practice Address - Phone:402-371-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist