Provider Demographics
NPI:1598013922
Name:ADAMCZAK, NATHAN RYAN (DPT, ATC-L, CSCS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RYAN
Last Name:ADAMCZAK
Suffix:
Gender:M
Credentials:DPT, ATC-L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 VAN BUREN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5541
Mailing Address - Country:US
Mailing Address - Phone:704-628-6053
Mailing Address - Fax:
Practice Address - Street 1:1001 VAN BUREN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5541
Practice Address - Country:US
Practice Address - Phone:704-628-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic