Provider Demographics
NPI:1558819367
Name:TELLEZ, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 IRVING ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2453
Mailing Address - Country:US
Mailing Address - Phone:410-499-5395
Mailing Address - Fax:
Practice Address - Street 1:3220 17TH ST NW
Practice Address - Street 2:SUITE 10
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2135
Practice Address - Country:US
Practice Address - Phone:202-436-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1407225700000X
VA19013663225700000X
MDR02274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist