Provider Demographics
NPI:1881863223
Name:USHAK, NATALIA BOHDANNA (PT)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:BOHDANNA
Last Name:USHAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3751
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-3751
Mailing Address - Country:US
Mailing Address - Phone:831-457-1800
Mailing Address - Fax:831-457-1802
Practice Address - Street 1:1335 CYPRESS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3537
Practice Address - Country:US
Practice Address - Phone:909-305-1383
Practice Address - Fax:909-305-1435
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist