Provider Demographics
NPI:1831136258
Name:DUTY, TERESA NAN (PT)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:NAN
Last Name:DUTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:NAN
Other - Last Name:DUTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:435 SAINT MICHAELS DR
Mailing Address - Street 2:A202
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7672
Mailing Address - Country:US
Mailing Address - Phone:505-984-8881
Mailing Address - Fax:550-598-4155
Practice Address - Street 1:435 SAINT MICHAELS DR
Practice Address - Street 2:A202
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7672
Practice Address - Country:US
Practice Address - Phone:505-984-8881
Practice Address - Fax:550-598-4155
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1831136258Medicare UPIN