Provider Demographics
NPI:1225130214
Name:HERRMANN, NATHAN ALLAN (MPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALLAN
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N. HURSTBOURNE PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:765-455-2122
Mailing Address - Fax:765-455-3122
Practice Address - Street 1:2312 S DIXON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6401
Practice Address - Country:US
Practice Address - Phone:765-455-2122
Practice Address - Fax:765-455-3122
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008662A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist