Provider Demographics
NPI:1699984005
Name:STICKELMAN, CORBY RYAN (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:CORBY
Middle Name:RYAN
Last Name:STICKELMAN
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6870
Mailing Address - Country:US
Mailing Address - Phone:308-696-0983
Mailing Address - Fax:
Practice Address - Street 1:3205 S OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6870
Practice Address - Country:US
Practice Address - Phone:308-696-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer