Provider Demographics
NPI:1518431972
Name:BECHTEL, NATHANIEL BURNS (MK, LAT, ATC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:BURNS
Last Name:BECHTEL
Suffix:
Gender:M
Credentials:MK, LAT, ATC
Other - Prefix:
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:BECHTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:209 E MALLARD DR APT 320
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6617
Mailing Address - Country:US
Mailing Address - Phone:986-210-6413
Mailing Address - Fax:
Practice Address - Street 1:2619 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6722
Practice Address - Country:US
Practice Address - Phone:208-706-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDAT-7442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program