Provider Demographics
NPI:1710160882
Name:BRICKEN, NATHAN D (PT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:D
Last Name:BRICKEN
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:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2530
Mailing Address - Country:US
Mailing Address - Phone:606-637-1830
Mailing Address - Fax:606-637-1832
Practice Address - Street 1:83 DEWEY ST
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-7923
Practice Address - Country:US
Practice Address - Phone:606-886-9888
Practice Address - Fax:606-886-9416
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100407210Medicaid