Provider Demographics
NPI:1225206535
Name:WEBB, NATHANIEL R (PT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:R
Last Name:WEBB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7761
Mailing Address - Country:US
Mailing Address - Phone:602-933-3124
Mailing Address - Fax:
Practice Address - Street 1:765 N 114TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5003
Practice Address - Country:US
Practice Address - Phone:602-933-7778
Practice Address - Fax:602-933-4296
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10969225100000X
AZ8802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36160300Medicaid
WIP00602506OtherRR MEDICARE
AZ493509Medicaid
AZ493509Medicaid
WI01994-0310Medicare PIN
WI46236-0310Medicare PIN