Provider Demographics
NPI:1871644377
Name:LOWRY, NATHAN (PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LOWRY
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 1:47-675 NUKUPUU ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5510
Mailing Address - Country:US
Mailing Address - Phone:206-854-8864
Mailing Address - Fax:
Practice Address - Street 1:47-675 NUKUPUU ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5510
Practice Address - Country:US
Practice Address - Phone:206-854-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009877225100000X
HI2795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0317000OtherL & I
WA0317044OtherL & I
WA0317051OtherL & I
WA0317049OtherL & I
WA0317044OtherL & I
WA0317049OtherL & I
WAG8924690Medicare PIN
WAG8924685Medicare PIN