MEDICARE: MR. NATHANIEL JASON CHRISTADOSS P.T.

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	1169447	TX

General Provider Information

NPI Number	:	1568550861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL JASON CHRISTADOSS P.T.

Provider Business Mailing Address
First Line	:	2212 SAM RAYBURN HWY
Second Line	:	STE 200
City	:	MELISSA
State	:	TX
Zip	:	75454-2674
Country	:	US
Telephone Number	:	972-837-4450
Fax Number	:	972-837-4451

Provider Business Practice Location Address
First Line	:	2212 SAM RAYBURN HWY
Second Line	:	STE 200
City	:	MELISSA
State	:	TX
Zip	:	75454-2674
Country	:	US
Telephone Number	:	972-837-4450
Fax Number	:	972-837-4451

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	01/07/2011

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