Provider Demographics
NPI:1003009929
Name:TEAGUE, MICHELLE MUNDY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MUNDY
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 W MCDERMOTT DR STE 50
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6400
Mailing Address - Country:US
Mailing Address - Phone:972-359-1288
Mailing Address - Fax:972-359-9652
Practice Address - Street 1:1223 W MCDERMOTT DR STE 50
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-359-1288
Practice Address - Fax:972-359-9652
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist