MEDICARE: NATALIE M STANISLAV

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1992585764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATALIE M STANISLAV

Provider Business Mailing Address
First Line	:	3035 CIMARRON PASS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8647
Country	:	US
Telephone Number	:	972-965-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 CIMARRON PASS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8647
Country	:	US
Telephone Number	:	972-965-9353
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	NATALIE M STANISLAV
Credential	:	PT, DPT
Telephone Number	:	972-965-9353

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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