Provider Demographics
NPI:1114161635
Name:TEICHEIRA, LORY M (PT)
Entity Type:Individual
Prefix:MS
First Name:LORY
Middle Name:M
Last Name:TEICHEIRA
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 1:306 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2512
Mailing Address - Country:US
Mailing Address - Phone:707-769-0915
Mailing Address - Fax:707-769-9244
Practice Address - Street 1:306 BASSETT ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2512
Practice Address - Country:US
Practice Address - Phone:707-769-0915
Practice Address - Fax:707-769-9244
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist