Provider Demographics
NPI:1538483672
Name:JOAN TEKULA, DPM
Entity Type:Organization
Organization Name:JOAN TEKULA, DPM
Other - Org Name:THRIVE AT HOME, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKULA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-264-6664
Mailing Address - Street 1:250 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2263
Mailing Address - Country:US
Mailing Address - Phone:203-264-6664
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2263
Practice Address - Country:US
Practice Address - Phone:203-264-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies