Provider Demographics
NPI:1891981965
Name:BADENHOP, TERESA S (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:S
Last Name:BADENHOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-9463
Mailing Address - Country:US
Mailing Address - Phone:419-287-4801
Mailing Address - Fax:
Practice Address - Street 1:4041 W SYLVANIA AVE
Practice Address - Street 2:SUITE102
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4465
Practice Address - Country:US
Practice Address - Phone:419-471-0400
Practice Address - Fax:419-471-0403
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist