Provider Demographics
NPI:1922154665
Name:EVERS, TERESA DEGEORGE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DEGEORGE
Last Name:EVERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:LYN
Other - Last Name:DEGEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3409 RED BAY CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-999-2438
Mailing Address - Fax:573-815-2990
Practice Address - Street 1:1600 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-3889
Practice Address - Fax:573-815-2990
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist