Provider Demographics
NPI:1114403326
Name:LIST, NATHAN ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANDREW
Last Name:LIST
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 1:4808 SEQUOIA ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4622
Mailing Address - Country:US
Mailing Address - Phone:620-560-4589
Mailing Address - Fax:
Practice Address - Street 1:3001 DOVER AVE STE B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-8999
Practice Address - Country:US
Practice Address - Phone:707-428-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-058922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic