Provider Demographics
NPI:1649592973
Name:WEEKS, NATALIE LILLIAN (PT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LILLIAN
Last Name:WEEKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:LILLIAN
Other - Last Name:O NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-735-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32882225100000X
TX1214183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301729501Medicaid
TX875T35OtherBCBS
TX875T35OtherBCBS