Individual
MR. NATHAN R. SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3066 E MERIDIAN PARK LOOP STE 101, WASILLA, AK 99654
(907) 205-5945
(907) 205-5948
Mailing address
PO BOX 873895, WASILLA, AK 99687-3895
(480) 695-3343
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5063
AZ
2251E1300X
Clinical Electrophysiology Physical Therapist
Primary
109306
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1651715
—
AK
Enumeration date
02/13/2006
Last updated
09/18/2018
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