Provider Demographics
NPI:1730122821
Name:TEETERS, CHAD A (LPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:TEETERS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 UNION CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4878
Mailing Address - Country:US
Mailing Address - Phone:513-645-2246
Mailing Address - Fax:513-645-2233
Practice Address - Street 1:8737 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4878
Practice Address - Country:US
Practice Address - Phone:513-645-2246
Practice Address - Fax:513-645-2233
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000547709OtherANTHEM
OHP00607505OtherMEDICARE RAILROAD
OH2675332Medicaid
OH2675332Medicaid
OHP00607505OtherMEDICARE RAILROAD