Healthcare Provider Details

I. General information

NPI: 1710570353
Provider Name (Legal Business Name): NATHAN THIREY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 COLUMBUS ST
WILMINGTON OH
45177
US

IV. Provider business mailing address

PO BOX 867
WILMINGTON OH
45177-0867
US

V. Phone/Fax

Practice location:
  • Phone: 937-725-3569
  • Fax:
Mailing address:
  • Phone: 937-725-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: