Provider Demographics
NPI:1144086265
Name:TOMETICH, NATHAN (DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:TOMETICH
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 1:102 MAIN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MCADENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28101-9708
Mailing Address - Country:US
Mailing Address - Phone:704-560-6135
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:MCADENVILLE
Practice Address - State:NC
Practice Address - Zip Code:28101-7908
Practice Address - Country:US
Practice Address - Phone:704-560-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist