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NPI Code Detail

MEDICARE: NATHAN THOMAS

MEDICARE: NATHAN THOMAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianIN

General Provider Information

NPI Number : 1568326866
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN THOMAS
Provider Business Mailing Address
First Line : 5601 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7145
Country : US
Telephone Number : 260-459-6040
Fax Number :
Provider Business Practice Location Address
First Line : 6131 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-4905
Country : US
Telephone Number : 260-459-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “ NATHAN THOMAS ” Practice Location

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