Provider Demographics
NPI:1720363906
Name:MCGINN-VAN HALL, TERESA MARIE
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:MCGINN-VAN HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:MCGINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:405 PENNSYLVANIA AVE
Mailing Address - Street 2:APALACHIN ELEMENTARY SCHOOL
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-2411
Mailing Address - Country:US
Mailing Address - Phone:607-687-6289
Mailing Address - Fax:
Practice Address - Street 1:405 PENNSYLVANIA AVE
Practice Address - Street 2:APALACHIN ELEMENTARY SCHOOL
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-2411
Practice Address - Country:US
Practice Address - Phone:607-687-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist