Provider Demographics
NPI:1255037198
Name:SEABERG, NATHANAEL THOMAS (DPT)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:THOMAS
Last Name:SEABERG
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 1:3290 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2023
Mailing Address - Country:US
Mailing Address - Phone:319-665-2630
Mailing Address - Fax:319-665-2631
Practice Address - Street 1:3290 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2023
Practice Address - Country:US
Practice Address - Phone:319-665-2630
Practice Address - Fax:319-665-2631
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist