Provider Demographics
NPI:1932875416
Name:HORTON, NATHANIEL (DPT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:HORTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2153
Mailing Address - Country:US
Mailing Address - Phone:617-298-2225
Mailing Address - Fax:
Practice Address - Street 1:10 FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2153
Practice Address - Country:US
Practice Address - Phone:617-298-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6028225100000X
MAPTL26725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist