Provider Demographics
NPI:1831767417
Name:NADRCHAL, KYLE JOSEPH (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:NADRCHAL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 N 148TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4561
Mailing Address - Country:US
Mailing Address - Phone:402-660-3917
Mailing Address - Fax:
Practice Address - Street 1:17800 GEORGE MILLER PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-3300
Practice Address - Country:US
Practice Address - Phone:402-289-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer