Provider Demographics
NPI:1982010526
Name:MIKER, NATHAN (ATC, MS IN ED, VA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MIKER
Suffix:
Gender:M
Credentials:ATC, MS IN ED, VA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6942
Mailing Address - Country:US
Mailing Address - Phone:757-683-3677
Mailing Address - Fax:
Practice Address - Street 1:LR HILL SPORTS COMPLEX
Practice Address - Street 2:4251 POWHATAN AVE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23529-0001
Practice Address - Country:US
Practice Address - Phone:757-683-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer