Provider Demographics
NPI:1790558542
Name:HALLSWORT6H, NATASHA AMALIA (LMT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:AMALIA
Last Name:HALLSWORT6H
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SE ROSE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3941
Mailing Address - Country:US
Mailing Address - Phone:541-891-2748
Mailing Address - Fax:888-892-3772
Practice Address - Street 1:714 SE ROSE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3941
Practice Address - Country:US
Practice Address - Phone:541-891-2748
Practice Address - Fax:888-892-3772
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty