Provider Demographics
NPI:1518348572
Name:THOMAS, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 STAGE RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2866
Mailing Address - Country:US
Mailing Address - Phone:901-371-0732
Mailing Address - Fax:
Practice Address - Street 1:6600 STAGE RD
Practice Address - Street 2:SUITE 129
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2866
Practice Address - Country:US
Practice Address - Phone:901-371-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist