Provider Demographics
NPI:1164916078
Name:O'SULLIVAN, TERESA MARIE STEIL (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE STEIL
Last Name:O'SULLIVAN
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 1:700 HEATHROW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-8721
Mailing Address - Country:US
Mailing Address - Phone:121-755-3197
Mailing Address - Fax:
Practice Address - Street 1:1700 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6420
Practice Address - Country:US
Practice Address - Phone:217-553-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070001865OtherSTATE LICENSE NUMBER
IL070011865OtherPT LICENSE