Provider Demographics
NPI:1295722585
Name:WEILER, NATHAN RICHARD (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:RICHARD
Last Name:WEILER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8883 HETZE RD
Mailing Address - Street 2:
Mailing Address - City:MILLADORE
Mailing Address - State:WI
Mailing Address - Zip Code:54454-9709
Mailing Address - Country:US
Mailing Address - Phone:715-457-4721
Mailing Address - Fax:715-295-8938
Practice Address - Street 1:2050 4TH AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1910
Practice Address - Country:US
Practice Address - Phone:715-346-4772
Practice Address - Fax:715-295-8938
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3850392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer