Provider Demographics
NPI:1083752331
Name:KAUK, NATHAN DAVID (DPT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:DAVID
Last Name:KAUK
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 1:6224 FAYETTEVILLE RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-484-0033
Mailing Address - Fax:919-484-3008
Practice Address - Street 1:6224 FAYETTEVILLE RD
Practice Address - Street 2:STE. 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-484-0033
Practice Address - Fax:919-484-3008
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212201Medicaid
NC068CAOtherBCBS OF NC
NC7212201Medicaid