Provider Demographics
NPI:1821704560
Name:HOWELL, TEAGAN
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:
Last Name:HOWELL
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 1:1321 COUNTY ROAD 248
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MO
Mailing Address - Zip Code:65254-9547
Mailing Address - Country:US
Mailing Address - Phone:660-728-9770
Mailing Address - Fax:
Practice Address - Street 1:1321 COUNTY ROAD 248
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MO
Practice Address - Zip Code:65254-9547
Practice Address - Country:US
Practice Address - Phone:660-728-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MO2023001739225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer