Provider Demographics
NPI:1326000761
Name:PRIBYL, THOMAS GARY (ATC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GARY
Last Name:PRIBYL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10586 US HIGHWAY 87 S
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-5719
Mailing Address - Country:US
Mailing Address - Phone:512-657-1795
Mailing Address - Fax:
Practice Address - Street 1:3007 N BEN WILSON ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5731
Practice Address - Country:US
Practice Address - Phone:361-485-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17952255A2300X
PA0039782255A2300X
IN36001657A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003978OtherSTATE LICENSE
TX1795OtherSTATE LICENSE
IN36001657AOtherINDIANA PROFESSIONAL LICENSING AGENCY, ATHLETIC TRAINERS BOARD