Provider Demographics
NPI:1740482967
Name:ISABELLA, TERESA A (LMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:ISABELLA
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 1:4740 NW 44TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-7837
Mailing Address - Country:US
Mailing Address - Phone:352-502-2809
Mailing Address - Fax:
Practice Address - Street 1:6998 N US HIGHWAY 27
Practice Address - Street 2:SUITE 110
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-8906
Practice Address - Country:US
Practice Address - Phone:352-502-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist