Provider Demographics
NPI:1336271758
Name:TELLO, DAMARIS (MSPT)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:TELLO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8662 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7112
Mailing Address - Country:US
Mailing Address - Phone:954-295-8801
Mailing Address - Fax:
Practice Address - Street 1:8662 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7112
Practice Address - Country:US
Practice Address - Phone:954-295-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19091OtherLICENSE