Provider Demographics
NPI:1144570557
Name:PENA, NATASHA LEIGH (DPT, PTA)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LEIGH
Last Name:PENA
Suffix:
Gender:F
Credentials:DPT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 SEMINOLE TRL STE U2
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2836
Mailing Address - Country:US
Mailing Address - Phone:434-939-9524
Mailing Address - Fax:434-939-9679
Practice Address - Street 1:6420 SEMINOLE TRL STE U2
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22923-2836
Practice Address - Country:US
Practice Address - Phone:434-939-9524
Practice Address - Fax:434-939-9679
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2090902225200000X
VA2306603413225200000X
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305216268OtherPHYSICAL THERAPIST LICENSE