1477722528 NPI number — TERESA M AMBROSIA-JENSEN PT

Table of content: TERESA M AMBROSIA-JENSEN PT (NPI 1477722528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477722528 NPI number — TERESA M AMBROSIA-JENSEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBROSIA-JENSEN
Provider First Name:
TERESA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477722528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 ELDORADO PKWY # 102-20TR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-6510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-310-9170
Provider Business Mailing Address Fax Number:
469-310-1701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5855 MILTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-310-1700
Provider Business Practice Location Address Fax Number:
469-310-1701
Provider Enumeration Date:
02/22/2008

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:  1082998 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1082998 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com