Provider Demographics
NPI:1548239197
Name:PETREE, TEENA JAMES (PT)
Entity Type:Individual
Prefix:
First Name:TEENA
Middle Name:JAMES
Last Name:PETREE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TEENA
Other - Middle Name:JAMES
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1400 THAMES DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2733
Mailing Address - Country:US
Mailing Address - Phone:972-424-5072
Mailing Address - Fax:
Practice Address - Street 1:17817 DAVENPORT RD
Practice Address - Street 2:SUITE 230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5871
Practice Address - Country:US
Practice Address - Phone:972-732-7797
Practice Address - Fax:972-732-7794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4321235OtherAETNA
TX86719TOtherBCBS INDIVIDUAL ID
TX4321235OtherAETNA