Provider Demographics
NPI:1295871143
Name:RATKOVICH, NATALIE G (LMP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:G
Last Name:RATKOVICH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N MULLAN RD STE L-10
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4042
Mailing Address - Country:US
Mailing Address - Phone:509-924-9500
Mailing Address - Fax:509-924-9515
Practice Address - Street 1:1420 N MULLAN RD STE L-10
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4042
Practice Address - Country:US
Practice Address - Phone:509-924-9500
Practice Address - Fax:509-924-9515
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0159006OtherL &I