Provider Demographics
NPI:1932229150
Name:SCANNELL, THERESE (MPT)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:SCANNELL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1847
Mailing Address - Country:US
Mailing Address - Phone:770-443-2788
Mailing Address - Fax:678-325-0687
Practice Address - Street 1:36 THOMAS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1847
Practice Address - Country:US
Practice Address - Phone:770-443-2788
Practice Address - Fax:678-325-0687
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist