Provider Demographics
NPI:1265639629
Name:REFFITT, NATHAN PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:PAUL
Last Name:REFFITT
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 1:2235 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-5081
Mailing Address - Country:US
Mailing Address - Phone:270-781-1151
Mailing Address - Fax:270-781-1959
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:UNIT 104 BUILDING 1
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6295
Practice Address - Country:US
Practice Address - Phone:270-686-3441
Practice Address - Fax:270-686-3450
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY532436OtherANTHEM
KY7920408OtherAETNA
KY00394006Medicare PIN