Provider Demographics
NPI:1457543720
Name:FOLSOM, THERESE MARIE (MT)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2677
Mailing Address - Country:US
Mailing Address - Phone:573-268-4353
Mailing Address - Fax:
Practice Address - Street 1:810 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4863
Practice Address - Country:US
Practice Address - Phone:573-449-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006013298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist