Provider Demographics
NPI:1700038767
Name:SQUIER, NATHANIEL J (DPT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:J
Last Name:SQUIER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 DAKOTA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3696
Mailing Address - Country:US
Mailing Address - Phone:402-494-5173
Mailing Address - Fax:402-494-5151
Practice Address - Street 1:3900 DAKOTA AVE STE 6
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3696
Practice Address - Country:US
Practice Address - Phone:402-494-5173
Practice Address - Fax:402-494-5151
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist