MEDICARE: STEVEN TEAGUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40QB00103300	OTHER	NJ	LICENSE #

General Provider Information

NPI Number	:	1679683171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN TEAGUE

Provider Business Mailing Address
First Line	:	105 WINDING LN
Second Line	:
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-2421
Country	:	US
Telephone Number	:	856-786-4979
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 SUNSET RD
Second Line	:	STE 5A
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1126
Country	:	US
Telephone Number	:	609-835-4801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/30/2007

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Directions to “ STEVEN TEAGUE ” Practice Location

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