MEDICARE: NATASHA LEIGH PENA DPT, PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2090902	TX
2	225200000X	Physical Therapy Assistant	2306603413	VA
3	225100000X	Physical Therapist		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305216268	OTHER	VA	PHYSICAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1144570557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA LEIGH PENA DPT, PTA

Provider Business Mailing Address
First Line	:	6420 SEMINOLE TRL STE U2
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-2836
Country	:	US
Telephone Number	:	434-939-9524
Fax Number	:	434-939-9679

Provider Business Practice Location Address
First Line	:	6420 SEMINOLE TRL STE U2
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-2836
Country	:	US
Telephone Number	:	434-939-9524
Fax Number	:	434-939-9679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	02/01/2024

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