Provider Demographics
NPI:1477892354
Name:BRIGANTI, NATHAN EDWARD
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:EDWARD
Last Name:BRIGANTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 AVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3801
Mailing Address - Country:US
Mailing Address - Phone:443-805-1568
Mailing Address - Fax:
Practice Address - Street 1:4601 MARTIN LUTHER KING JR AVE SW
Practice Address - Street 2:SOUTHWEST
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1131
Practice Address - Country:US
Practice Address - Phone:202-261-3585
Practice Address - Fax:202-318-8174
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPTA000058225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant