Healthcare Provider Details

I. General information

NPI: 1013332550
Provider Name (Legal Business Name): NATHANIEL JONES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 WEST HIGHWAY 34
GRAND ISLAND NE
68801
US

IV. Provider business mailing address

1405 W HIGHWAY 34
GRAND ISLAND NE
68801
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-6397
  • Fax: 308-382-0125
Mailing address:
  • Phone: 308-382-6397
  • Fax: 308-382-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1267
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: