Provider Demographics
NPI:1861468985
Name:LINCOLN, TERESA M (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:LEMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:42 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302
Mailing Address - Country:US
Mailing Address - Phone:518-399-6861
Mailing Address - Fax:518-399-6864
Practice Address - Street 1:42 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302
Practice Address - Country:US
Practice Address - Phone:518-399-6861
Practice Address - Fax:518-399-6864
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0188531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00761880Medicaid
NY56563AMedicare ID - Type Unspecified
S89793Medicare UPIN