Provider Demographics
NPI:1790951929
Name:WOLLO, TERESA ANN (CRT, RCP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:WOLLO
Suffix:
Gender:F
Credentials:CRT, RCP
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRT,RCP
Mailing Address - Street 1:5925 MAPLE AVE
Mailing Address - Street 2:150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6515
Mailing Address - Country:US
Mailing Address - Phone:214-353-9090
Mailing Address - Fax:214-353-9594
Practice Address - Street 1:5925 MAPLE AVE
Practice Address - Street 2:150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6515
Practice Address - Country:US
Practice Address - Phone:214-353-9090
Practice Address - Fax:214-353-9594
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651792278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1754376-01Medicaid
TX1754376-01Medicaid