Individual
MR. NATHAN TODD LUNDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
535 N LOCUST GROVE RD STE 170, MERIDIAN, ID 83642-9379
(208) 917-2660
(208) 917-2630
Mailing address
535 N LOCUST GROVE RD STE 170, MERIDIAN, ID 83642-9379
(208) 917-2660
(208) 917-2630
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7243
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7243
STATE LICENSE
ID
Enumeration date
05/25/2021
Last updated
05/25/2021
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