Provider Demographics
NPI:1336325380
Name:VONAHSEN, NATHAN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:VONAHSEN
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11603 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5707
Mailing Address - Country:US
Mailing Address - Phone:402-968-4740
Mailing Address - Fax:
Practice Address - Street 1:11603 TYLER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-5707
Practice Address - Country:US
Practice Address - Phone:402-968-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2287225100000X
IA4103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist