Healthcare Provider Details

I. General information

NPI: 1255027108
Provider Name (Legal Business Name): NATALIA SAMANTHA MANDUJANO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 N IH 35 101
BUDA TX
78610
US

IV. Provider business mailing address

11325 LOST MAPLES TRL
AUSTIN TX
78748-2434
US

V. Phone/Fax

Practice location:
  • Phone: 512-994-4115
  • Fax:
Mailing address:
  • Phone: 254-466-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1374680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: