Provider Demographics
NPI:1639452550
Name:TOLERO, THERESA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:TOLERO
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 1:116 RIDGECREST LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-2006
Mailing Address - Country:US
Mailing Address - Phone:662-902-8691
Mailing Address - Fax:
Practice Address - Street 1:116 RIDGECREST LN
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-2006
Practice Address - Country:US
Practice Address - Phone:662-902-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist