Provider Demographics
NPI:1851987648
Name:MCCALL, NATHAN ETIENNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ETIENNE
Last Name:MCCALL
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 1:3625 SE 30TH TER APT 203
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-4103
Mailing Address - Country:US
Mailing Address - Phone:530-370-5159
Mailing Address - Fax:
Practice Address - Street 1:1700 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2489
Practice Address - Country:US
Practice Address - Phone:530-370-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist