Basic Information
| Provider Information | |||||||||
| NPI: | 1144766825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | NATHAN | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 DEERPATH LN E | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601158951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055884971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1525 W LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601153989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157530211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2017 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096.004355 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
ID Information
| ID | Type | State | Issuer | Description | 096.004355 | 01 | IL | ATHLETIC TRAINER | OTHER |