Provider Demographics
NPI:1366845364
Name:KANE, NATASHA (DPT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 ALTA ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6104
Mailing Address - Country:US
Mailing Address - Phone:530-478-1933
Mailing Address - Fax:530-478-1937
Practice Address - Street 1:569 SEARLS AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3063
Practice Address - Country:US
Practice Address - Phone:530-478-1933
Practice Address - Fax:530-478-1937
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist