Provider Demographics
NPI:1598358798
Name:SHANK, NATHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:SHANK
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 1:234 WEST ST S UNIT 4
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8160
Mailing Address - Country:US
Mailing Address - Phone:641-236-4506
Mailing Address - Fax:641-236-4316
Practice Address - Street 1:234 WEST ST S UNIT 4
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-8160
Practice Address - Country:US
Practice Address - Phone:641-236-4506
Practice Address - Fax:641-236-4316
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist