Active NPI
Patrick Jay Liebsack, ATC
- Athletic Trainer
- Hastings, NE
National Provider Identifier
1164624219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 32
- Practice address
- 715 N Saint Joseph Ave
Hastings, NE 68901-4451 - Phone
- (402) 984-1909
- NPI assigned
- Jun 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 32 | NE | Primary |
Addresses
Primary practice location
715 N Saint Joseph Ave
Hastings, NE 68901-4451
Mailing address
1212 W Koenig St
Grand Island, NE 68801-5748
Phone (308) 384-4407
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32 | NE | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164624219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 W KOENIG ST",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688015748",
"telephone_number": "308-384-4407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 N SAINT JOSEPH AVE",
"city": "HASTINGS",
"state": "NE",
"postal_code": "689014451",
"telephone_number": "402-984-1909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBSACK",
"first_name": "PATRICK",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NE",
"license": "32",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hastings, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.