Provider Demographics
NPI:1295496545
Name:TEAGUE, EMILY (DPT)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17638 ROCKWOOD ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-4034
Mailing Address - Country:US
Mailing Address - Phone:636-209-2916
Mailing Address - Fax:
Practice Address - Street 1:322 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-5917
Practice Address - Country:US
Practice Address - Phone:636-227-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022004167225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty