Provider Demographics
NPI:1700232279
Name:BRATTINGA, NATASJA YOLANDA-LUCILLA
Entity Type:Individual
Prefix:MRS
First Name:NATASJA
Middle Name:YOLANDA-LUCILLA
Last Name:BRATTINGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 WHISPERING KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4177
Mailing Address - Country:US
Mailing Address - Phone:248-935-1317
Mailing Address - Fax:
Practice Address - Street 1:5225 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1916
Practice Address - Country:US
Practice Address - Phone:248-673-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist