Provider Demographics
NPI:1841539780
Name:TEAL, JACK GEORGE (PT)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:GEORGE
Last Name:TEAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:8350 DALLAS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4020
Practice Address - Country:US
Practice Address - Phone:469-362-8433
Practice Address - Fax:469-362-8451
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1226819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist