Provider Demographics
NPI:1417063934
Name:LINDELL, TERESA ANNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANNE
Last Name:LINDELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANNE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:117 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2152
Mailing Address - Country:US
Mailing Address - Phone:716-862-0567
Mailing Address - Fax:716-862-0571
Practice Address - Street 1:2540 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9410
Practice Address - Country:US
Practice Address - Phone:716-862-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRBO979Medicare UPIN