Provider Demographics
NPI:1629418736
Name:DUCKWORTH, TERESA T (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:T
Last Name:DUCKWORTH
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 1:100 PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-5501
Mailing Address - Country:US
Mailing Address - Phone:601-849-6440
Mailing Address - Fax:601-849-1332
Practice Address - Street 1:805 3RD ST SW
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3923
Practice Address - Country:US
Practice Address - Phone:601-849-2734
Practice Address - Fax:601-849-2735
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT2015OtherLICENSE