Provider Demographics
NPI:1144499161
Name:MACK, NATALIE C (LPTA)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:C
Last Name:MACK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:CELLERINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:6508 SHERRI LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-4126
Mailing Address - Country:US
Mailing Address - Phone:817-929-0480
Mailing Address - Fax:
Practice Address - Street 1:6508 SHERRI LN
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-4126
Practice Address - Country:US
Practice Address - Phone:817-929-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2053587225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant