Provider Demographics
NPI:1134490204
Name:FELTEN, THERESA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LYNN
Last Name:FELTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 LAKE GIBSON LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3545
Mailing Address - Country:US
Mailing Address - Phone:863-853-2069
Mailing Address - Fax:
Practice Address - Street 1:223 LAKE GIBSON LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3545
Practice Address - Country:US
Practice Address - Phone:863-853-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064199208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics