Provider Demographics
NPI:1881037638
Name:FELSTEAD, TERESA L (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:FELSTEAD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OPP DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4493
Mailing Address - Country:US
Mailing Address - Phone:850-301-1935
Mailing Address - Fax:850-301-1937
Practice Address - Street 1:600 OPP DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4493
Practice Address - Country:US
Practice Address - Phone:850-301-1935
Practice Address - Fax:850-301-1937
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23468225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant