Provider Demographics
NPI:1467668368
Name:TERESA L. WHITE
Entity Type:Organization
Organization Name:TERESA L. WHITE
Other - Org Name:PRO MEDICAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERPROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-983-7766
Mailing Address - Street 1:PRO MEDICAL REHAB 460 MYLAN PARK LANE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501
Mailing Address - Country:US
Mailing Address - Phone:304-983-7766
Mailing Address - Fax:304-983-7768
Practice Address - Street 1:PRO MEDICAL REHAB 460 MYLAN PARK LANE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501
Practice Address - Country:US
Practice Address - Phone:304-983-7766
Practice Address - Fax:304-983-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19990357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty