Provider Demographics
NPI:1407134968
Name:DE GRAAF, NATHAN ALLAN (DPT)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALLAN
Last Name:DE GRAAF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 WARD ROAD BLDG 1 #100
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1820
Mailing Address - Country:US
Mailing Address - Phone:303-432-2112
Mailing Address - Fax:303-432-2844
Practice Address - Street 1:5400 WARD ROAD BLDG 1 #100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1820
Practice Address - Country:US
Practice Address - Phone:303-432-2112
Practice Address - Fax:303-432-2844
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-11358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist