Provider Demographics
NPI:1730719196
Name:THOBER, AMANDA KATE (ATC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KATE
Last Name:THOBER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 VERONA AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-1033
Mailing Address - Country:US
Mailing Address - Phone:308-293-0323
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:NE
Practice Address - Zip Code:68876-9639
Practice Address - Country:US
Practice Address - Phone:308-293-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE0807022802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer