Provider Demographics
NPI:1073784542
Name:PALENZUELA, TERESA (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PALENZUELA
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 1:24 HIBISCUS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1516
Mailing Address - Country:US
Mailing Address - Phone:727-581-7405
Mailing Address - Fax:
Practice Address - Street 1:1150 8TH AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3193
Practice Address - Country:US
Practice Address - Phone:727-581-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant