Provider Demographics
NPI:1821196080
Name:NALTY, THERESA J (PT)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:J
Last Name:NALTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15813 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-2161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15813 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-2161
Practice Address - Country:US
Practice Address - Phone:206-240-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2025-01-10
Deactivation Date:2015-02-23
Deactivation Code:
Reactivation Date:2025-01-09
Provider Licenses
StateLicense IDTaxonomies
TX1084044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist