Provider Demographics
NPI:1689775645
Name:BINGHAM, TERESA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JEAN
Last Name:BINGHAM
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 1:1450 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9112
Mailing Address - Country:US
Mailing Address - Phone:937-653-7333
Mailing Address - Fax:937-652-4574
Practice Address - Street 1:1450 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9112
Practice Address - Country:US
Practice Address - Phone:937-653-7333
Practice Address - Fax:937-652-4574
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6562225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist