Provider Demographics
NPI:1720663529
Name:WOLTERMAN, TERESA (DPT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WOLTERMAN
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 1:10523 FARMLAND DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1774
Mailing Address - Country:US
Mailing Address - Phone:513-703-3657
Mailing Address - Fax:513-524-0965
Practice Address - Street 1:10058 COOLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-9509
Practice Address - Country:US
Practice Address - Phone:765-647-0808
Practice Address - Fax:765-647-0926
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010258225100000X
IN05014085A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist