Provider Demographics
NPI:1568905222
Name:GUNARATNE, NATASHA (DPT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:GUNARATNE
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 1:24422 AVENIDA DE LA CARLOTA
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3636
Mailing Address - Country:US
Mailing Address - Phone:949-340-6927
Mailing Address - Fax:949-215-7246
Practice Address - Street 1:24422 AVENIDA DE LA CARLOTA
Practice Address - Street 2:SUITE 190
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3636
Practice Address - Country:US
Practice Address - Phone:949-340-6927
Practice Address - Fax:949-215-7246
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 292407225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA292704OtherPT LICENSE