Provider Demographics
NPI:1689393795
Name:THOMAS, NATHAN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 N COUNTY ROAD 425 W
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7833
Mailing Address - Country:US
Mailing Address - Phone:812-605-1850
Mailing Address - Fax:
Practice Address - Street 1:901 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2399
Practice Address - Country:US
Practice Address - Phone:812-605-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer