Provider Demographics
NPI:1902387798
Name:ESPEJON, TEDDY LESANDRO CHUA (PT)
Entity Type:Individual
Prefix:MR
First Name:TEDDY LESANDRO
Middle Name:CHUA
Last Name:ESPEJON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 TREASURE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4863
Mailing Address - Country:US
Mailing Address - Phone:682-459-3433
Mailing Address - Fax:
Practice Address - Street 1:420 LANTERN BEND DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2832
Practice Address - Country:US
Practice Address - Phone:832-249-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1197959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist