Provider Demographics
NPI:1487303681
Name:LONGNECKER, NATALIE (PTA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LONGNECKER
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 1:1240 N NEW YORK AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2711
Mailing Address - Country:US
Mailing Address - Phone:620-621-6285
Mailing Address - Fax:
Practice Address - Street 1:2160 ZINNIA LN
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2042
Practice Address - Country:US
Practice Address - Phone:620-624-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03445225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant