Provider Demographics
NPI:1659092104
Name:VRBA, TYLER G (MSE, ATC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:G
Last Name:VRBA
Suffix:
Gender:M
Credentials:MSE, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:CERESCO
Mailing Address - State:NE
Mailing Address - Zip Code:68017-0376
Mailing Address - Country:US
Mailing Address - Phone:402-276-4302
Mailing Address - Fax:
Practice Address - Street 1:5905 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2235
Practice Address - Country:US
Practice Address - Phone:402-436-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE706OtherATHELTIC TRAINER LICENSE NUMBER