Provider Demographics
NPI:1508531120
Name:DAVIS, NATHAN CLAUDE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CLAUDE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1932
Mailing Address - Country:US
Mailing Address - Phone:810-397-2074
Mailing Address - Fax:
Practice Address - Street 1:1200 WRIGHT AVE # 1133
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1133
Practice Address - Country:US
Practice Address - Phone:800-321-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist