Provider Demographics
NPI:1366107211
Name:CANDELARIA, NATHAN (PT, DPT, ART)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:CANDELARIA
Suffix:
Gender:M
Credentials:PT, DPT, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MUNICIPAL DRIVE
Mailing Address - Street 2:FL 2
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1016
Mailing Address - Country:US
Mailing Address - Phone:484-378-7987
Mailing Address - Fax:484-786-9788
Practice Address - Street 1:200 MUNICIPAL DRIVE
Practice Address - Street 2:FL 2
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1016
Practice Address - Country:US
Practice Address - Phone:484-378-7987
Practice Address - Fax:484-786-9788
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2153853862OtherPHONENUMBER
PA1041603000001Medicaid
PA2153852862OtherHAND AND SHOULDER