Provider Demographics
NPI:1053659060
Name:MAGNUSON, NATHAN (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MAGNUSON
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 1:110 HAVERHILL RD
Mailing Address - Street 2:STE 524
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:30 LANCASTER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1704
Practice Address - Country:US
Practice Address - Phone:617-367-4700
Practice Address - Fax:617-367-4701
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist