Provider Demographics
NPI:1801857115
Name:MARTILIK, TERESA MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MARTILIK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:85 MEADOW RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-4500
Mailing Address - Country:US
Mailing Address - Phone:540-420-9608
Mailing Address - Fax:
Practice Address - Street 1:1147 SUSAN AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1043
Practice Address - Country:US
Practice Address - Phone:540-459-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260010052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer