Provider Demographics
NPI:1851804041
Name:KSIAZEK, THOMAS KENNETH (MSAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KENNETH
Last Name:KSIAZEK
Suffix:
Gender:M
Credentials:MSAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6279
Mailing Address - Country:US
Mailing Address - Phone:402-276-6590
Mailing Address - Fax:
Practice Address - Street 1:1115 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6108
Practice Address - Country:US
Practice Address - Phone:308-568-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer