Provider Demographics
NPI:1902254550
Name:HOOVER, NATHANIEL DEAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DEAN
Last Name:HOOVER
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 1:805 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1127
Mailing Address - Country:US
Mailing Address - Phone:920-648-2400
Mailing Address - Fax:920-648-2444
Practice Address - Street 1:805 ELM ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1127
Practice Address - Country:US
Practice Address - Phone:920-648-2400
Practice Address - Fax:920-648-2400
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13418-24225100000X
WI13418 - 24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist