Provider Demographics
NPI:1699775338
Name:SHORT, NATHAN (PT)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:SHORT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 CAMELOT LN
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6911
Mailing Address - Country:US
Mailing Address - Phone:419-420-0207
Mailing Address - Fax:
Practice Address - Street 1:1725 WESTERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1345
Practice Address - Country:US
Practice Address - Phone:419-422-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2502214Medicaid
OHSH4137142Medicare ID - Type Unspecified
OHSH4137144Medicare ID - Type Unspecified
OHSH4137147Medicare ID - Type Unspecified
OHSH4137143Medicare ID - Type Unspecified
OHSH4137148Medicare ID - Type Unspecified
OH2502214Medicaid