Provider Demographics
NPI:1174677553
Name:ASTRAB, THERESA (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:ASTRAB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36133 US HWY 19N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:36484-1453
Mailing Address - Country:US
Mailing Address - Phone:727-784-3131
Mailing Address - Fax:727-784-3131
Practice Address - Street 1:36133 US HWY 19N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:36484-1453
Practice Address - Country:US
Practice Address - Phone:727-784-3131
Practice Address - Fax:727-784-3131
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70648Medicare ID - Type Unspecified