Provider Demographics
NPI:1336624931
Name:VOSE, NATALIA (PTA)
Entity Type:Individual
Prefix:MS
First Name:NATALIA
Middle Name:
Last Name:VOSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4591 CHARNOCK DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2330
Mailing Address - Country:US
Mailing Address - Phone:949-294-6156
Mailing Address - Fax:
Practice Address - Street 1:24551 RAYMOND WAY STE 125
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4478
Practice Address - Country:US
Practice Address - Phone:949-540-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49451225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant