Provider Demographics
NPI:1003804410
Name:WATHEN, NORMAN DANIEL (ATC ;CSCS;NSCA-CPT)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:DANIEL
Last Name:WATHEN
Suffix:
Gender:M
Credentials:ATC ;CSCS;NSCA-CPT
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Mailing Address - Street 1:5301 SAMPSON DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-3504
Mailing Address - Country:US
Mailing Address - Phone:330-759-2314
Mailing Address - Fax:330-941-3191
Practice Address - Street 1:5301 SAMPSON DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-3504
Practice Address - Country:US
Practice Address - Phone:330-759-2314
Practice Address - Fax:330-941-3191
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAT-1742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer