Provider Demographics
NPI:1871685016
Name:HUME, JEFFREY RYAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RYAN
Last Name:HUME
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 1:11203 SCOTT TYSONS LN
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-3611
Mailing Address - Country:US
Mailing Address - Phone:402-426-8225
Mailing Address - Fax:
Practice Address - Street 1:2848 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1041
Practice Address - Country:US
Practice Address - Phone:402-426-7362
Practice Address - Fax:402-426-7952
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer