Healthcare Provider Details

I. General information

NPI: 1679656185
Provider Name (Legal Business Name): NATHAN TROUT MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE LN UNIT 109
DURANGO CO
81301-7488
US

IV. Provider business mailing address

34 MILLER DR
DURANGO CO
81301-4731
US

V. Phone/Fax

Practice location:
  • Phone: 970-403-5939
  • Fax: 877-839-2679
Mailing address:
  • Phone: 970-403-5939
  • Fax: 877-839-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number7984
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7984
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: