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General NPI Number Information
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NPI Number | 1306409834
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Entity Type | Individual
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Provider Name | NATHAN ORTH ATC
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Gender | Male
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 104 SALUDA POINTE DR
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City | LEXINGTON
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State | SC
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Zip | 29072-7295
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Country | US
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Telephone | 803-296-9209
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 E CEDAR RIDGE RD
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City | SANDY
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State | UT
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Zip | 84094-5608
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Country | US
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Telephone | 801-599-1065
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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