Provider Demographics
NPI:1073093340
Name:BOMBECK, AUDREANA M (PT)
Entity Type:Individual
Prefix:
First Name:AUDREANA
Middle Name:M
Last Name:BOMBECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AUDREANA
Other - Middle Name:M
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2116 ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2373
Mailing Address - Country:US
Mailing Address - Phone:308-390-6056
Mailing Address - Fax:
Practice Address - Street 1:2116 ATLANTA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2373
Practice Address - Country:US
Practice Address - Phone:308-390-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist