Provider Demographics
NPI:1154846749
Name:MENESES, NATHANIEL SIROMA (DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:SIROMA
Last Name:MENESES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 4TH AVE SW APT 8
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2573
Mailing Address - Country:US
Mailing Address - Phone:904-910-5823
Mailing Address - Fax:
Practice Address - Street 1:22415 68TH AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2444
Practice Address - Country:US
Practice Address - Phone:253-395-1131
Practice Address - Fax:253-395-1171
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170269652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic