Provider Demographics
NPI:1376737999
Name:LIMBACH, CHARLES GREGORY (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:GREGORY
Last Name:LIMBACH
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3339
Mailing Address - Country:US
Mailing Address - Phone:308-236-5703
Mailing Address - Fax:
Practice Address - Street 1:3207 12TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3339
Practice Address - Country:US
Practice Address - Phone:308-236-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer