Basic Information
| Provider Information | |||||||||
| NPI: | 1205245677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWAN | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 W ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | BLACK RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546159108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152845361 | ||||||||
| FaxNumber: | 7152847166 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 W ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | BLACK RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546159108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152845361 | ||||||||
| FaxNumber: | 7152847166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2014 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 12844 | WI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.