Provider Demographics
NPI:1811532419
Name:TEAGUE, CARI ELLEN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:ELLEN
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 WRANGLER DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-6442
Mailing Address - Country:US
Mailing Address - Phone:336-314-6330
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVENUE
Practice Address - Street 2:#160 AND #200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-545-5000
Practice Address - Fax:336-544-5876
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-38882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer