=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174872808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATASHA BULAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2012
-----------------------------------------------------
Last Update Date | 09/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5317 OLD MIDDLETON RD, ROOM #102 'HOT STONE THERAPY & MASSAGE'
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-438-7920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5317 OLD MIDDLETON RD, ROOM #102 'HOT STONE THERAPY & MASSAGE'
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-438-7920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------