Provider Demographics
NPI:1578792867
Name:CONTOS, THERESA A
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:CONTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:CONTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:275 HICKOK AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3344
Mailing Address - Country:US
Mailing Address - Phone:315-727-5697
Mailing Address - Fax:315-463-6821
Practice Address - Street 1:124 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1736
Practice Address - Country:US
Practice Address - Phone:315-727-5697
Practice Address - Fax:315-463-6821
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005796-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist