Provider Demographics
NPI:1023471919
Name:WILSON, NATASCHA NUNN (MPT)
Entity type:Individual
Prefix:
First Name:NATASCHA
Middle Name:NUNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18430 SHANNA DR
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3206
Mailing Address - Country:US
Mailing Address - Phone:810-656-6614
Mailing Address - Fax:
Practice Address - Street 1:18430 SHANNA DR
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3206
Practice Address - Country:US
Practice Address - Phone:810-656-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist