Provider Demographics
NPI:1124806922
Name:MESSMORE, NATHANIEL (MT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:MESSMORE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:ME
Mailing Address - Zip Code:04489-0006
Mailing Address - Country:US
Mailing Address - Phone:207-992-4000
Mailing Address - Fax:207-558-3285
Practice Address - Street 1:17 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3383
Practice Address - Country:US
Practice Address - Phone:207-992-4000
Practice Address - Fax:207-558-3285
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT7496225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist