Provider Demographics
NPI:1396371787
Name:ROBERTSON ELDER, TERESA BLAKE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:BLAKE
Last Name:ROBERTSON ELDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:ROBERTSON ELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:120 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4727
Practice Address - Country:US
Practice Address - Phone:678-641-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP191762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic