Provider Demographics
NPI:1386266716
Name:ETEAKI, NATALIE (PTA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ETEAKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 GREENDALE CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7791
Mailing Address - Country:US
Mailing Address - Phone:817-690-9770
Mailing Address - Fax:
Practice Address - Street 1:2600 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7989
Practice Address - Country:US
Practice Address - Phone:817-354-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2123953208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation