Provider Demographics
NPI:1093004301
Name:NAYDEN, TERESA L (PTA)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:NAYDEN
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 1:318 E WASHINGTON ST # B
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-1645
Mailing Address - Country:US
Mailing Address - Phone:217-778-5439
Mailing Address - Fax:
Practice Address - Street 1:318 E WASHINGTON ST # B
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1645
Practice Address - Country:US
Practice Address - Phone:217-778-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.001510225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant