Healthcare Provider Details

I. General information

NPI: 1629275706
Provider Name (Legal Business Name): NATASHA ANDERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA ROGERS PTA

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S STATE ROAD 57
WASHINGTON IN
47501-4373
US

IV. Provider business mailing address

617 CHURCH ST
VINCENNES IN
47591-1139
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-4516
  • Fax: 812-254-4765
Mailing address:
  • Phone: 812-895-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003284A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: