Provider Demographics
NPI:1740692151
Name:HINES, NATHAN ALAN (PT, DPT, AT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALAN
Last Name:HINES
Suffix:
Gender:M
Credentials:PT, DPT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 W RIDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1618
Mailing Address - Country:US
Mailing Address - Phone:937-308-3539
Mailing Address - Fax:
Practice Address - Street 1:2714 W RIDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1618
Practice Address - Country:US
Practice Address - Phone:937-308-3539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.014738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist