Healthcare Provider Details

I. General information

NPI: 1225320963
Provider Name (Legal Business Name): THERESA RENEE FOLSOM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 WOODS ST 116 WWOODS ST
PERRY FL
32348-6428
US

IV. Provider business mailing address

116 WOODS ST
PERRY FL
32348-6428
US

V. Phone/Fax

Practice location:
  • Phone: 850-223-3354
  • Fax:
Mailing address:
  • Phone: 850-223-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License NumberMA0028154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: