Provider Demographics
NPI:1841783644
Name:KAMPWERTH, NATHAN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:KAMPWERTH
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 MOUSER ST APT 39
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2678
Mailing Address - Country:US
Mailing Address - Phone:618-407-8275
Mailing Address - Fax:
Practice Address - Street 1:188 THORNTON RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:IN
Practice Address - Zip Code:47243-9714
Practice Address - Country:US
Practice Address - Phone:812-866-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012922A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist