Provider Demographics
NPI:1568570455
Name:CROTEAU, NATHALIE (PT)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2573 STONEMAN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5631
Mailing Address - Country:US
Mailing Address - Phone:907-488-3613
Mailing Address - Fax:
Practice Address - Street 1:3455 REWAK DR
Practice Address - Street 2:STE 106
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5003
Practice Address - Country:US
Practice Address - Phone:907-457-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1078OtherLICENSE #