Healthcare Provider Details

I. General information

NPI: 1649952904
Provider Name (Legal Business Name): NATALIE BASSETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1130 BEACHVIEW ST STE 110
DALLAS TX
75218-3704
US

IV. Provider business mailing address

1130 BEACHVIEW ST STE 110
DALLAS TX
75218-3704
US

V. Phone/Fax

Practice location:
  • Phone: 214-538-2559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1379165
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: