Healthcare Provider Details

I. General information

NPI: 1265993885
Provider Name (Legal Business Name): NATASHA HITE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W MALONEY AVE
GALLUP NM
87301-5489
US

IV. Provider business mailing address

PO BOX 903
JAMESTOWN NM
87347-0903
US

V. Phone/Fax

Practice location:
  • Phone: 505-488-2615
  • Fax:
Mailing address:
  • Phone: 505-290-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: