Provider Demographics
NPI:1629859251
Name:THOMAS, NATALIE (PTA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 W BELL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9702
Mailing Address - Country:US
Mailing Address - Phone:623-234-4171
Mailing Address - Fax:623-234-4173
Practice Address - Street 1:12515 W BELL RD STE 103
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9702
Practice Address - Country:US
Practice Address - Phone:623-234-4171
Practice Address - Fax:623-234-4173
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014735225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant