Provider Demographics
NPI:1356572127
Name:SANTELLI, TERESA (LMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SANTELLI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 FAIRPORT RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2003
Mailing Address - Country:US
Mailing Address - Phone:585-749-0959
Mailing Address - Fax:585-377-1997
Practice Address - Street 1:1387 FAIRPORT RD
Practice Address - Street 2:SUITE 520
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2003
Practice Address - Country:US
Practice Address - Phone:585-749-0959
Practice Address - Fax:585-377-1997
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
017985-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist