Provider Demographics
NPI:1659780021
Name:NASH, TERESA L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:NASH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 S EOLA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-6401
Mailing Address - Country:US
Mailing Address - Phone:630-820-1700
Mailing Address - Fax:
Practice Address - Street 1:2380 S EOLA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-6401
Practice Address - Country:US
Practice Address - Phone:630-820-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.008054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist