Provider Demographics
NPI:1649208737
Name:LADD, NATHAN R (PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:R
Last Name:LADD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-685-8230
Mailing Address - Fax:270-685-8223
Practice Address - Street 1:1126 TRIPLETT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3155
Practice Address - Country:US
Practice Address - Phone:270-689-2008
Practice Address - Fax:270-689-2052
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87001319Medicaid
KYP77923Medicare UPIN
KY87001319Medicaid