Provider Demographics
NPI:1538462692
Name:PIERCE, NATHAN M
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:M
Last Name:PIERCE
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 1:1760 RESTON PKWY
Mailing Address - Street 2:#403
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3388
Mailing Address - Country:US
Mailing Address - Phone:703-230-1760
Mailing Address - Fax:703-230-1761
Practice Address - Street 1:1760 RESTON PKWY
Practice Address - Street 2:#403
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3388
Practice Address - Country:US
Practice Address - Phone:703-230-1760
Practice Address - Fax:703-230-1761
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist