Provider Demographics
NPI:1083228654
Name:DEBLAUW, NATHAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:DEBLAUW
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 1:1214 W LOYOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5102
Mailing Address - Country:US
Mailing Address - Phone:773-274-1769
Mailing Address - Fax:773-274-1937
Practice Address - Street 1:1214 W LOYOLA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-5102
Practice Address - Country:US
Practice Address - Phone:773-274-1769
Practice Address - Fax:773-274-1937
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070025121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist