Provider Demographics
NPI:1629200373
Name:TEITELMAN, JUDY (PT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:TEITELMAN
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 1:180 WELLS AVE
Mailing Address - Street 2:302A
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3328
Mailing Address - Country:US
Mailing Address - Phone:617-332-5105
Mailing Address - Fax:
Practice Address - Street 1:180 WELLS AVE
Practice Address - Street 2:302A
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3328
Practice Address - Country:US
Practice Address - Phone:617-332-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6644225100000X, 2251E1300X, 2251G0304X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic