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NPI Code Detail

MEDICARE: DR. NATHANIEL SIROMA MENESES DPT

MEDICARE: DR. NATHANIEL SIROMA MENESES 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
12251X0800XOrthopedic Physical Therapist2017026965MO

General Provider Information

NPI Number : 1154846749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHANIEL SIROMA MENESES DPT
Provider Business Mailing Address
First Line : 15411 4TH AVE SW APT 8
Second Line :
City : BURIEN
State : WA
Zip : 98166-2573
Country : US
Telephone Number : 904-910-5823
Fax Number :
Provider Business Practice Location Address
First Line : 22415 68TH AVE S
Second Line :
City : KENT
State : WA
Zip : 98032-2444
Country : US
Telephone Number : 253-395-1131
Fax Number : 253-395-1171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2017
Last Update Date : 08/04/2017

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