Provider Demographics
NPI:1386663664
Name:TELLIER, DARLENE PATRICE (PT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:PATRICE
Last Name:TELLIER
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 1:16950 N BAY RD
Mailing Address - Street 2:APARTMENT #707
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4240
Mailing Address - Country:US
Mailing Address - Phone:561-702-9946
Mailing Address - Fax:305-585-0091
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:ROOM 146
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-6334
Practice Address - Fax:305-585-0091
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist