Provider Demographics
NPI:1396373700
Name:NIEDZWIEDZ, NATALIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:NIEDZWIEDZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 PELL PL UNIT 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4140
Mailing Address - Country:US
Mailing Address - Phone:925-330-7889
Mailing Address - Fax:
Practice Address - Street 1:8665 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9503
Practice Address - Country:US
Practice Address - Phone:619-465-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist