Provider Demographics
NPI:1356887194
Name:EVERETT, NATHAN MICHAEL (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:EVERETT
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4643
Mailing Address - Country:US
Mailing Address - Phone:307-222-8993
Mailing Address - Fax:307-222-5758
Practice Address - Street 1:433 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4643
Practice Address - Country:US
Practice Address - Phone:307-222-8993
Practice Address - Fax:307-222-5758
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT16792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic