Provider Demographics
NPI:1952672248
Name:ADDINGTON, NATHAN JOE (PTA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOE
Last Name:ADDINGTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 HIGHWAY 3406
Mailing Address - Street 2:
Mailing Address - City:MAYKING
Mailing Address - State:KY
Mailing Address - Zip Code:41837-9014
Mailing Address - Country:US
Mailing Address - Phone:606-633-0491
Mailing Address - Fax:
Practice Address - Street 1:200 NURSING HOME LN
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6896
Practice Address - Country:US
Practice Address - Phone:606-639-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02337225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant