Provider Demographics
NPI:1174589121
Name:CONSBRUCK, ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CONSBRUCK
Suffix:
Gender:M
Credentials:DPT
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 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-675-1853
Mailing Address - Fax:308-210-4121
Practice Address - Street 1:11757 S HIGHWAY 6 STE 1
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-8077
Practice Address - Country:US
Practice Address - Phone:402-905-9089
Practice Address - Fax:402-504-4671
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03731225100000X
NE2433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025112300Medicaid
NE41213595668002A002OtherTRIWEST
NE216813OtherCOVENTRY
NE39960OtherBCBS
NE278993Medicare ID - Type Unspecified