Provider Demographics
NPI:1144668245
Name:HEGGESETH, NATHAN PAUL (DPT)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:PAUL
Last Name:HEGGESETH
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:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-0319
Mailing Address - Country:US
Mailing Address - Phone:608-847-5100
Mailing Address - Fax:608-847-5110
Practice Address - Street 1:610 MCEVOY ST
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1438
Practice Address - Country:US
Practice Address - Phone:608-847-5100
Practice Address - Fax:608-847-5110
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12403-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist