Provider Demographics
NPI:1013393586
Name:SHORT, NATALIE ROSE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROSE
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 NW MILITARY HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2422
Mailing Address - Country:US
Mailing Address - Phone:210-402-4077
Mailing Address - Fax:210-402-2922
Practice Address - Street 1:1802 NW MILITARY HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2422
Practice Address - Country:US
Practice Address - Phone:210-402-4077
Practice Address - Fax:210-402-2922
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116695225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist