Healthcare Provider Details

I. General information

NPI: 1235435249
Provider Name (Legal Business Name): NATASHA BASTRON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 09/16/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S MAIN ST
DELTA CO
81416-2407
US

IV. Provider business mailing address

1573 HICKORY DR
MONTROSE CO
81401
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-9773
  • Fax:
Mailing address:
  • Phone: 720-666-1917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number13032
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: