Provider Demographics
NPI:1811943160
Name:NATE, DANIEL G JR (MPT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:G
Last Name:NATE
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1610
Mailing Address - Country:US
Mailing Address - Phone:856-853-7778
Mailing Address - Fax:
Practice Address - Street 1:1765 SPRINGDALE RD
Practice Address - Street 2:BUILDING A
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2177
Practice Address - Country:US
Practice Address - Phone:856-751-8787
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00975300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00975300OtherPT STATE ID NUMBER