Provider Demographics
NPI:1629040977
Name:TEAHAN, DONALD MCGREGOR (PT,DPT,OCS,ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MCGREGOR
Last Name:TEAHAN
Suffix:
Gender:M
Credentials:PT,DPT,OCS,ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 59TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4630
Mailing Address - Country:US
Mailing Address - Phone:941-798-6189
Mailing Address - Fax:941-798-6087
Practice Address - Street 1:1894 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4630
Practice Address - Country:US
Practice Address - Phone:941-798-6189
Practice Address - Fax:941-798-6087
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT84142251S0007X, 2251X0800X, 225100000X
FLAL3492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer