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General NPI Number Information
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NPI Number | 1518539527
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Entity Type | Individual
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Provider Name | NATHAN WYATT PRUS DPT
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Gender | Male
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Dates
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Enumeration Date | 07/11/2021
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 600 CENTRAL AVE SE STE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-4650
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Country | US
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Telephone | 505-242-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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Country | US
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Telephone |
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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 | CP051940T
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License Number State | CO
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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 | CP035464T
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 304229
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0014919
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License Number State | DE
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP031224T
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License Number State | DE
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Taxonomy #6
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02245800
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License Number State | NJ
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28416
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License Number State | MD
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Taxonomy #8
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-2025-0197
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License Number State | NM
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