Provider Demographics
NPI:1588604771
Name:TELETCHEA, MARY K (MSPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:TELETCHEA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20684 JOHN J WILLIAMS HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4393
Mailing Address - Country:US
Mailing Address - Phone:302-945-0200
Mailing Address - Fax:302-945-6959
Practice Address - Street 1:20684 JOHN J WILLIAMS HWY STE 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4393
Practice Address - Country:US
Practice Address - Phone:302-945-0200
Practice Address - Fax:302-945-6959
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21176225100000X
DEJ1-0002210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist