Provider Demographics
NPI:1154819373
Name:DIMITROVA, NATALI
Entity Type:Individual
Prefix:
First Name:NATALI
Middle Name:
Last Name:DIMITROVA
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 1:1012 HARBOUR CT APT 1B
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5400
Mailing Address - Country:US
Mailing Address - Phone:847-749-7046
Mailing Address - Fax:
Practice Address - Street 1:1012 HARBOUR CT APT 1B
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5400
Practice Address - Country:US
Practice Address - Phone:847-749-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer