Provider Demographics
NPI:1245438902
Name:TEIXEIRA, THOMAS NELSON (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:NELSON
Last Name:TEIXEIRA
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 1:120 SHALLOTTE CROSSING PKWY
Mailing Address - Street 2:SUITE5 BOX 202
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-8117
Mailing Address - Country:US
Mailing Address - Phone:336-491-5022
Mailing Address - Fax:
Practice Address - Street 1:120 SHALLOTTE CROSSING PKWY
Practice Address - Street 2:SUITE 5 BOX 202
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-8117
Practice Address - Country:US
Practice Address - Phone:336-491-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53992251G0304X
NC39802251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics