Provider Demographics
NPI:1326374240
Name:STAFFORD, TERESA MULLINAX (LMTB)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MULLINAX
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LMTB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 PEELER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-5228
Mailing Address - Country:US
Mailing Address - Phone:864-902-8009
Mailing Address - Fax:
Practice Address - Street 1:1252 OVERBROOK DR
Practice Address - Street 2:SUITE#14
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1057
Practice Address - Country:US
Practice Address - Phone:864-902-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 3729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist