Provider Demographics
NPI:1386185643
Name:HOLTZAPPLE, NATHAN (ATC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:HOLTZAPPLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CAVALIER BLVD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1645
Mailing Address - Country:US
Mailing Address - Phone:859-322-2391
Mailing Address - Fax:
Practice Address - Street 1:68 CAVALIER BLVD
Practice Address - Street 2:SUITE 1700
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1645
Practice Address - Country:US
Practice Address - Phone:859-283-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer