Provider Demographics
NPI:1457052854
Name:PENDERGRASS, NATALIE S (LMT, E-RYT, YOMI)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:S
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:LMT, E-RYT, YOMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22. S. ALFRED AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-404-0849
Mailing Address - Fax:
Practice Address - Street 1:22. S. ALFRED AVENUE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-404-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 173C00000X
IL227.003186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No173C00000XOther Service ProvidersReflexologist