Basic Information
Provider Information
NPI: 1841599826
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RATAJCZAK
FirstName: NATASHA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 910 W VAN BUREN ST
Address2: SUITE 419
City: CHICAGO
State: IL
PostalCode: 606073523
CountryCode: US
TelephoneNumber: 8777091090
FaxNumber: 6308769187
Practice Location
Address1: 5677 OBERLIN DR
Address2: SUITE 106
City: SAN DIEGO
State: CA
PostalCode: 921211740
CountryCode: US
TelephoneNumber: 8584578419
FaxNumber: 8584570670
Other Information
ProviderEnumerationDate: 03/16/2011
LastUpdateDate: 07/17/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X070021428ILY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home