Active NPI
Nathan Louis Slade
- Physical Therapy Assistant
- Fairfax, VA
National Provider Identifier
1356952865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2306605670
- Practice address
- 10701 Main St
Fairfax, VA 22030-6904 - Phone
- (703) 273-7705
- NPI assigned
- Aug 10, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2306605670 | VA | Primary |
Addresses
Primary practice location
10701 Main St
Fairfax, VA 22030-6904
Mailing address
2911 Deer Hollow Way Unit 418
Fairfax, VA 22031-6048
Phone (757) 903-1411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2306605670 | VA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1356952865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2911 DEER HOLLOW WAY UNIT 418",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220316048",
"telephone_number": "757-903-1411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10701 MAIN ST",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220306904",
"telephone_number": "703-273-7705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLADE",
"first_name": "NATHAN",
"middle_name": "LOUIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-10",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "VA",
"license": "2306605670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.