MEDICARE: NATALIE AUTUMN WILSON 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	184460	AK

General Provider Information

NPI Number	:	1932066099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE AUTUMN WILSON PTA

Provider Business Mailing Address
First Line	:	3375 CHECKMATE DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4923
Country	:	US
Telephone Number	:	907-444-8469
Fax Number	:

Provider Business Practice Location Address
First Line	:	7985 E 16TH AVE STE 100
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-2896
Country	:	US
Telephone Number	:	907-373-9764
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ NATALIE AUTUMN WILSON PTA” Practice Location

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