Provider Demographics
NPI:1316134950
Name:MCINTOSH, NOLAN (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 N SAGINAW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3001
Mailing Address - Country:US
Mailing Address - Phone:989-837-1529
Mailing Address - Fax:989-837-2499
Practice Address - Street 1:2618 N SAGINAW RD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3001
Practice Address - Country:US
Practice Address - Phone:989-837-1529
Practice Address - Fax:989-837-2499
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010134912251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports