Provider Demographics
NPI:1669714093
Name:MIDDLEBROOKS, NATALIE (LMT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4678 TAMIAMI TRL
Mailing Address - Street 2:UNIT 107
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2900
Mailing Address - Country:US
Mailing Address - Phone:941-815-3029
Mailing Address - Fax:
Practice Address - Street 1:108 LELAND ST SE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9129
Practice Address - Country:US
Practice Address - Phone:941-815-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56869225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist