Provider Demographics
NPI:1679656185
Name:TROUT, NATHAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:TROUT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4731
Mailing Address - Country:US
Mailing Address - Phone:970-403-5939
Mailing Address - Fax:877-839-2679
Practice Address - Street 1:575 RIVERGATE LN UNIT 109
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7488
Practice Address - Country:US
Practice Address - Phone:970-403-5939
Practice Address - Fax:877-839-2679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7984225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803579Medicare ID - Type UnspecifiedPHYSICAL THERAPY