Provider Demographics
NPI:1114702669
Name:NESPODZANY, NATHAN JOSEPH
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOSEPH
Last Name:NESPODZANY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 OAKS XING
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1916
Mailing Address - Country:US
Mailing Address - Phone:269-685-9640
Mailing Address - Fax:
Practice Address - Street 1:390 OAKS XING
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1916
Practice Address - Country:US
Practice Address - Phone:269-685-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist