Provider Demographics
NPI:1043940679
Name:DELEGARD, NATHANIEL JAY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JAY
Last Name:DELEGARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 E SCHNEIDMILLER AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7065
Mailing Address - Country:US
Mailing Address - Phone:208-773-8111
Mailing Address - Fax:
Practice Address - Street 1:1610 E SCHNEIDMILLER AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7065
Practice Address - Country:US
Practice Address - Phone:208-773-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist