Provider Demographics
NPI:1689204661
Name:FOGELL, NATHAN P (ATC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:FOGELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 TOWNHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03275-2009
Mailing Address - Country:US
Mailing Address - Phone:603-630-4005
Mailing Address - Fax:
Practice Address - Street 1:38 TOWNHOUSE RD
Practice Address - Street 2:
Practice Address - City:ALLENSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03275-2009
Practice Address - Country:US
Practice Address - Phone:603-630-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer