Provider Demographics
NPI:1124256037
Name:HUSAIN, NATHALIE GRACE CANETE (PT)
Entity type:Individual
Prefix:MISS
First Name:NATHALIE GRACE
Middle Name:CANETE
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:GMMPCPI 214 WEST 5TH ST.,
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:GMMPCPI 214 WEST 5TH ST.,
Practice Address - Street 2:SUITE D & E
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist