Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 292407 | CA |
Y | 2251N0400X | Physical Therapist - Neurology | PT 292407 | CA |
NPI | 1568905222 |
---|---|
Provider Name | Natasha Gunaratne |
First Address | Laguna Hills, CA 92653-3636 |
Second Address | Laguna Hills, CA 92653-3636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292704 | PT LICENSE (01) | CA |