Provider Demographics
NPI:1093924235
Name:BRIEDWELL, TERESA ANN (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:BRIEDWELL
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 1:7601 E ROSADENE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9652
Mailing Address - Country:US
Mailing Address - Phone:573-817-3257
Mailing Address - Fax:573-256-2764
Practice Address - Street 1:1100 CLUB VILLAGE DR STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4411
Practice Address - Country:US
Practice Address - Phone:573-256-2777
Practice Address - Fax:573-256-2764
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist