Provider Demographics
NPI:1740889112
Name:NASTERNAK, NATHAN MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:NASTERNAK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 CORONADO CENTER DRIVE, SUITE 140
Mailing Address - Street 2:2212
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-312-4878
Mailing Address - Fax:702-312-4886
Practice Address - Street 1:750 CORONADO CENTER DRIVE, SUITE 140
Practice Address - Street 2:2212
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-312-4878
Practice Address - Fax:702-312-4886
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045962225100000X
NV4382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist