Provider Demographics
NPI:1225320963
Name:FOLSOM, THERESA RENEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:RENEE
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WOODS ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-6428
Mailing Address - Country:US
Mailing Address - Phone:850-223-3354
Mailing Address - Fax:
Practice Address - Street 1:116 WOODS ST
Practice Address - Street 2:116 WWOODS ST
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-6428
Practice Address - Country:US
Practice Address - Phone:850-223-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0028154111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography