Provider Demographics
NPI:1184213274
Name:CHLEBORAD, ANDREW NATHAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NATHAN
Last Name:CHLEBORAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 S 87TH ST
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4428
Mailing Address - Country:US
Mailing Address - Phone:402-709-7654
Mailing Address - Fax:
Practice Address - Street 1:50 STANLEY ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4430
Practice Address - Country:US
Practice Address - Phone:931-456-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist