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General NPI Number Information
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NPI Number | 1205242526
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Entity Type | Individual
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Provider Name | NATHAN KYLE MANN PT, DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1001 S 41ST ST E
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City | MUSKOGEE
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State | OK
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Zip | 74403-6253
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Country | US
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Telephone | 918-781-6429
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Fax |
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Provider Business Mailing Address
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Address Line | 6143 S FULTON AVE
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City | TULSA
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State | OK
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Zip | 74136-2018
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Country | US
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Telephone | 918-633-0266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4897
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10946
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License Number State | AZ
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