Provider Demographics
NPI:1780825331
Name:GORBET, NATHANIEL (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:GORBET
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LINDEN ST.
Mailing Address - Street 2:APT 1
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134
Mailing Address - Country:US
Mailing Address - Phone:603-721-6077
Mailing Address - Fax:
Practice Address - Street 1:25 LINDEN ST.
Practice Address - Street 2:APT 1
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134
Practice Address - Country:US
Practice Address - Phone:603-721-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer