Provider Demographics
NPI:1568786663
Name:DOVE, NATHAN BRENT (PTA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:BRENT
Last Name:DOVE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 ROPER MOUNTAIN RD
Mailing Address - Street 2:APT. 572
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5101
Mailing Address - Country:US
Mailing Address - Phone:864-360-3620
Mailing Address - Fax:
Practice Address - Street 1:311 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2157
Practice Address - Country:US
Practice Address - Phone:864-261-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2467225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant