MEDICARE: MRS. JORDAN L NATALE DPT

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	225100000X	Physical Therapist	24668	MD

General Provider Information

NPI Number	:	1154754976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JORDAN L NATALE DPT

Provider Business Mailing Address
First Line	:	7310 RITCHIE HWY
Second Line	:	SUITE 500
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3065
Country	:	US
Telephone Number	:	410-766-4047
Fax Number	:	410-766-4049

Provider Business Practice Location Address
First Line	:	31 MAGOTHY BEACH RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4423
Country	:	US
Telephone Number	:	410-766-4047
Fax Number	:	410-766-4049

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

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	05/10/2016

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