Provider Demographics
NPI:1841507035
Name:ESKER, THERESA M (PTA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:ESKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:610 PARK ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1856
Mailing Address - Country:US
Mailing Address - Phone:618-977-6704
Mailing Address - Fax:
Practice Address - Street 1:9350 GREEN PARK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7211
Practice Address - Country:US
Practice Address - Phone:618-977-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008003803225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant