Healthcare Provider Details

I. General information

NPI: 1093832743
Provider Name (Legal Business Name): TERESA ANN RISTINE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA ANN ARMBRUSTER PTA

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GREENBANK RD
WILMINGTON DE
19808-3164
US

IV. Provider business mailing address

31 NATHALIE CT
HOCKESSIN DE
19707-1145
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0101
  • Fax:
Mailing address:
  • Phone: 302-234-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000264
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: