MEDICARE: NATALIE ALFONSO 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	PTA22509	FL

General Provider Information

NPI Number	:	1790121465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE ALFONSO PTA

Provider Business Mailing Address
First Line	:	14401 LAKE CRESCENT PL
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-3036
Country	:	US
Telephone Number	:	305-496-8605
Fax Number	:

Provider Business Practice Location Address
First Line	:	14401 LAKE CRESCENT PL
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-3036
Country	:	US
Telephone Number	:	305-495-8605
Fax Number	:

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

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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