Provider Demographics
NPI:1184955031
Name:FOREMAN, NATHAN JON (DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JON
Last Name:FOREMAN
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 1:5100 W ELDORADO PKWY
Mailing Address - Street 2:#102-20KT
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:214-346-9105
Mailing Address - Fax:214-346-9125
Practice Address - Street 1:4809 COLE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3578
Practice Address - Country:US
Practice Address - Phone:214-346-9105
Practice Address - Fax:214-346-9125
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1193982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist