Healthcare Provider Details

I. General information

NPI: 1225487382
Provider Name (Legal Business Name): NATALIE THOMAS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 MARSHA SHARP FWY DOOR #3
LUBBOCK TX
79407-2504
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 415
LOS ANGELES CA
90064-1536
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-0131
  • Fax:
Mailing address:
  • Phone: 424-225-1845
  • Fax: 310-933-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1234297
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: