Provider Demographics
NPI:1750365821
Name:OLTMANS, TERESA ANNE (MPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:OLTMANS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANNE
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:13060 2ND ST SPC 58
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5636
Mailing Address - Country:US
Mailing Address - Phone:909-797-6470
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE
Practice Address - Street 2:UNIT C & D
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-665-1510
Practice Address - Fax:951-665-1515
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM040ZMedicare PIN
CABM040ZMedicare PIN