Provider Demographics
NPI:1295051985
Name:FOGELSON, NATALIE CHANTALL (PT, CLT-LANA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:CHANTALL
Last Name:FOGELSON
Suffix:
Gender:F
Credentials:PT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 W BELL RD STE 22
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2749
Mailing Address - Country:US
Mailing Address - Phone:623-580-9323
Mailing Address - Fax:623-580-9318
Practice Address - Street 1:4025 W BELL RD STE 22
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2749
Practice Address - Country:US
Practice Address - Phone:623-580-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5298332B00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z139037Medicare PIN