Healthcare Provider Details

I. General information

NPI: 1366787129
Provider Name (Legal Business Name): NATALIE MARIE WINBLAD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 TOWN CENTER DR
RANCHO CUCAMONGA CA
91730-0360
US

IV. Provider business mailing address

555 GUILFORD AVE.
CLAREMONT CA
91711
US

V. Phone/Fax

Practice location:
  • Phone: 909-948-1124
  • Fax:
Mailing address:
  • Phone: 909-241-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: