MEDICARE: NATHANIEL PAUL PRYOR PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4430	NV

General Provider Information

NPI Number	:	1225634215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL PAUL PRYOR PT, DPT

Provider Business Mailing Address
First Line	:	121 BIG HOLLOW RD
Second Line	:
City	:	DEPOSIT
State	:	NY
Zip	:	13754-3604
Country	:	US
Telephone Number	:	607-725-4885
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 S FORT APACHE RD STE 100B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7693
Country	:	US
Telephone Number	:	607-725-4885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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