Provider Demographics
NPI:1518221191
Name:BENDER, NICHOLAS (LAT, ATC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 GUSTAV ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9323
Mailing Address - Country:US
Mailing Address - Phone:515-201-0346
Mailing Address - Fax:
Practice Address - Street 1:2701 PRAIRIE MEADOW DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-8001
Practice Address - Country:US
Practice Address - Phone:319-467-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0008002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer