Healthcare Provider Details

I. General information

NPI: 1912114810
Provider Name (Legal Business Name): NATALIE RENEE ENGLAND PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E US HIGHWAY 20
MICHIGAN CITY IN
46360-7424
US

IV. Provider business mailing address

104 KILLDEER AVE
TRAIL CREEK IN
46360-5714
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-7251
  • Fax:
Mailing address:
  • Phone: 219-879-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002939A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: