Provider Demographics
NPI:1609164862
Name:ASCENSAO, NATHALIE J (LMT)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:J
Last Name:ASCENSAO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2123 W MARTIN LUTHER KING JR BLOUVARD
Mailing Address - Street 2:STE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-873-1361
Mailing Address - Fax:813-873-1325
Practice Address - Street 1:2123 W MARTIN LUTHER KING JR BLOUVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-873-1361
Practice Address - Fax:813-873-1325
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA60758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist