Provider Demographics
NPI:1437933082
Name:CLEVELAND, TEASIE KAHREN (DPT)
Entity Type:Individual
Prefix:
First Name:TEASIE
Middle Name:KAHREN
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TEASIE
Other - Middle Name:KAHREN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6124 EDWARD ST APT 206
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-1647
Mailing Address - Country:US
Mailing Address - Phone:229-449-1253
Mailing Address - Fax:
Practice Address - Street 1:2404 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4335
Practice Address - Country:US
Practice Address - Phone:757-961-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016786225100000X
VACP024775T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist