Provider Demographics
NPI:1811549744
Name:DREW, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13168 NEW PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13168 NEW PARKLAND DR
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:VA
Practice Address - Zip Code:20171-3821
Practice Address - Country:US
Practice Address - Phone:571-277-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
VA2306601294225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No171W00000XOther Service ProvidersContractor