Provider Demographics
NPI:1427578756
Name:FOX, NATHAN ADAM (PT, DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ADAM
Last Name:FOX
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 MORGAN WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5142
Mailing Address - Country:US
Mailing Address - Phone:865-385-9061
Mailing Address - Fax:
Practice Address - Street 1:415 ELDERBERRY LN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6369
Practice Address - Country:US
Practice Address - Phone:828-252-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist