Provider Demographics
NPI:1407175870
Name:OLESCH, TERESA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:OLESCH
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 1:4107 HOHE ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7008
Mailing Address - Country:US
Mailing Address - Phone:907-235-0687
Mailing Address - Fax:907-235-4017
Practice Address - Street 1:4107 HOHE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7008
Practice Address - Country:US
Practice Address - Phone:907-235-0687
Practice Address - Fax:907-235-4017
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist