Provider Demographics
NPI:1851690309
Name:RANKIN, TERESA A (MT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:RANKIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3882
Mailing Address - Country:US
Mailing Address - Phone:719-338-5032
Mailing Address - Fax:
Practice Address - Street 1:8060 TREFOIL CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5767
Practice Address - Country:US
Practice Address - Phone:719-338-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist