Healthcare Provider Details

I. General information

NPI: 1083810147
Provider Name (Legal Business Name): NATHAN ALTHERR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E BROAD ST
COLUMBUS OH
43213-1476
US

IV. Provider business mailing address

996 OAKSHADE DR
GAHANNA OH
43230-3628
US

V. Phone/Fax

Practice location:
  • Phone: 614-575-9003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number02710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: