Provider Demographics
NPI:1225635394
Name:CASTANEDA, NATALIE DORA MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:DORA MARIE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CROSSCREEK DR APT C1
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2511
Mailing Address - Country:US
Mailing Address - Phone:972-898-4902
Mailing Address - Fax:
Practice Address - Street 1:35 CROSSCREEK DR APT C1
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2511
Practice Address - Country:US
Practice Address - Phone:972-898-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist