Provider Demographics
NPI:1689065971
Name:YODER, NATHAN (PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:YODER
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 1:306 CONNELL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2802
Mailing Address - Country:US
Mailing Address - Phone:731-592-1072
Mailing Address - Fax:
Practice Address - Street 1:306 CONNELL DR
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2802
Practice Address - Country:US
Practice Address - Phone:731-592-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6095225100000X
KY4736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist