Provider Demographics
NPI:1578034864
Name:CALLEJA, TEREASA RENEE (PT)
Entity Type:Individual
Prefix:
First Name:TEREASA
Middle Name:RENEE
Last Name:CALLEJA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8199 E LIPPINCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8359
Mailing Address - Country:US
Mailing Address - Phone:586-996-1012
Mailing Address - Fax:
Practice Address - Street 1:1515 CAL DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9016
Practice Address - Country:US
Practice Address - Phone:810-496-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist