Provider Demographics
NPI:1841238433
Name:WERTZ, NATHAN DANIEL (MS, PT, OMPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DANIEL
Last Name:WERTZ
Suffix:
Gender:M
Credentials:MS, PT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 BELLE CHASE WAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4282
Mailing Address - Country:US
Mailing Address - Phone:517-657-7790
Mailing Address - Fax:517-657-8893
Practice Address - Street 1:3410 BELLE CHASE WAY
Practice Address - Street 2:SUITE 700
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4282
Practice Address - Country:US
Practice Address - Phone:517-657-7790
Practice Address - Fax:517-657-8893
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NW010949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
30658OtherBCBS
64-00940OtherPHP
30658OtherBCBS