Provider Demographics
NPI:1407069479
Name:SUKHAPHADHANA, NATALIE NARUMOL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:NARUMOL
Last Name:SUKHAPHADHANA
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 1:2241 ENTRADA DEL SOL APT 2A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3992
Mailing Address - Country:US
Mailing Address - Phone:530-680-5446
Mailing Address - Fax:
Practice Address - Street 1:1700 N SMITH AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-3728
Practice Address - Country:US
Practice Address - Phone:530-680-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist