Provider Demographics
NPI:1134335656
Name:CRIBELLI, ANTHONY ADAM (PT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ADAM
Last Name:CRIBELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MOUSEL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-3628
Mailing Address - Country:US
Mailing Address - Phone:308-697-4182
Mailing Address - Fax:308-697-4179
Practice Address - Street 1:911 MOUSEL AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NE
Practice Address - Zip Code:69022-3628
Practice Address - Country:US
Practice Address - Phone:308-697-4182
Practice Address - Fax:308-697-4179
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024959-00Medicaid
NE10024959-00Medicaid