Provider Demographics
NPI:1295739795
Name:NACHTIGAL, DAVID JOHN (PT/RCP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:NACHTIGAL
Suffix:
Gender:M
Credentials:PT/RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2232
Mailing Address - Country:US
Mailing Address - Phone:785-742-7606
Mailing Address - Fax:785-742-4490
Practice Address - Street 1:700 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2232
Practice Address - Country:US
Practice Address - Phone:785-742-7606
Practice Address - Fax:785-742-4490
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1100497225100000X
NE321225100000X
KS16-00580227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100397240AMedicaid
KS0308450001Medicare NSC
KS012507001Medicare PIN