Provider Demographics
NPI:1568854693
Name:PODLINEVA, NATASHA (LMT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:PODLINEVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SE PALMBLAD RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7352
Mailing Address - Country:US
Mailing Address - Phone:503-267-8600
Mailing Address - Fax:
Practice Address - Street 1:10249 NE CLACKAMAS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3915
Practice Address - Country:US
Practice Address - Phone:503-206-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21022172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist