Provider Demographics
NPI:1316129760
Name:MACILVEEN, NATASHA A (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:A
Last Name:MACILVEEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0851
Mailing Address - Country:US
Mailing Address - Phone:503-281-5947
Mailing Address - Fax:
Practice Address - Street 1:202 WHITE AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9774
Practice Address - Country:US
Practice Address - Phone:509-996-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33938225100000X
OR5419225100000X
WAPT60392875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist