Healthcare Provider Details

I. General information

NPI: 1255013546
Provider Name (Legal Business Name): NATHAN GOCKEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST
PLAINVILLE CT
06062-1968
US

IV. Provider business mailing address

47 N MAIN ST
WEST HARTFORD CT
06107-1926
US

V. Phone/Fax

Practice location:
  • Phone: 860-517-8885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14099
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: