Provider Demographics
NPI:1134520786
Name:PASHO, BRYANT (ATC)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:PASHO
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 1:124 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-4801
Mailing Address - Country:US
Mailing Address - Phone:402-557-3300
Mailing Address - Fax:402-557-3339
Practice Address - Street 1:124 N 20TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-4801
Practice Address - Country:US
Practice Address - Phone:402-557-3300
Practice Address - Fax:402-557-3339
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer