Provider Demographics
NPI:1073962031
Name:HITCHENS, NATHAN (PTA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HITCHENS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:28001 SCHOENHERR RD
Practice Address - Street 2:STE 6
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4396
Practice Address - Country:US
Practice Address - Phone:586-806-6284
Practice Address - Fax:586-806-6274
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5502004875225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant