Provider Demographics
NPI:1619179488
Name:TEITELBAUM, DEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 BROADWAY ST
Mailing Address - Street 2:STE B
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7881
Mailing Address - Country:US
Mailing Address - Phone:713-436-3900
Mailing Address - Fax:713-436-3904
Practice Address - Street 1:730 HOPMEADOW ST
Practice Address - Street 2:REAR
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2225
Practice Address - Country:US
Practice Address - Phone:860-408-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233630225100000X
CT007319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist