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1386175636
TREVOR MITCHELL POLIVKA
LINCOLN, NE
NPI
1386175636
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: NE H13496390)
Enumeration Date
2017-03-27
Last Update Date
2017-03-29
Business Address
Mr. TREVOR MITCHELL POLIVKA
8100 N 1ST ST
LINCOLN, NE 68531-8924
Phone number: 402-937-2662
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Mailing Address
Mr. TREVOR MITCHELL POLIVKA
8100 N 1ST ST
LINCOLN, NE 68531-8924
Phone number: 402-937-2662
Copy
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