Healthcare Provider Details

I. General information

NPI: 1801002480
Provider Name (Legal Business Name): NATHANIEL GARNER HOPE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 SOUTH RAPIDS ROAD
MANITOWOC WI
54220-4146
US

IV. Provider business mailing address

2220 SOUTH 42ND ST. UNIT#6
MANITOWOC WI
54220
US

V. Phone/Fax

Practice location:
  • Phone: 920-684-1144
  • Fax: 920-482-0561
Mailing address:
  • Phone: 920-629-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10634-024
License Number StateWI

VII. Legacy identifiers

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

# 1
Identifier36123600
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: