Provider Demographics
NPI:1346859675
Name:ASENIME, NATARSHA SHAWNTELL (PTA)
Entity Type:Individual
Prefix:
First Name:NATARSHA
Middle Name:SHAWNTELL
Last Name:ASENIME
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:NATARSHA
Other - Middle Name:ASENIME
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:408 MONTPELIER LN
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3327
Mailing Address - Country:US
Mailing Address - Phone:469-879-1589
Mailing Address - Fax:
Practice Address - Street 1:408 MONTPELIER LN
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-3327
Practice Address - Country:US
Practice Address - Phone:469-879-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2065890225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant