MEDICARE: MRS. NATALIE ANASTASIA NELSON PTA, BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA49307	CA

General Provider Information

NPI Number	:	1316411143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE ANASTASIA NELSON PTA, BS

Provider Business Mailing Address
First Line	:	1901 E WILLOW ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-4362
Country	:	US
Telephone Number	:	714-883-9569
Fax Number	:

Provider Business Practice Location Address
First Line	:	23595 MOULTON PKWY STE E
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1939
Country	:	US
Telephone Number	:	949-900-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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