1982957692 NPI number — MRS. TEENA THOMAS JOSEPH PHYSICAL THERAPIST

Table of content: MRS. TEENA THOMAS JOSEPH PHYSICAL THERAPIST (NPI 1982957692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982957692 NPI number — MRS. TEENA THOMAS JOSEPH PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
TEENA
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEORGE
Provider Other First Name:
TEENA
Provider Other Middle Name:
ACHAMMA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982957692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 WINDING RIDGE DR
Provider Second Line Business Mailing Address:
APT # 2A
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-813-0366
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2916 HABANA WAY
Provider Second Line Business Practice Location Address:
HABANA HEALTH AND REHAB
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-309-0069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 27409 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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