Provider Demographics
NPI:1275776643
Name:NEISWONGER, NATALIE JONES (PT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JONES
Last Name:NEISWONGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:LYN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10443 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9181
Mailing Address - Country:US
Mailing Address - Phone:260-625-5005
Mailing Address - Fax:260-625-9004
Practice Address - Street 1:10443 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9181
Practice Address - Country:US
Practice Address - Phone:260-625-5005
Practice Address - Fax:260-625-9004
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006794A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist