Healthcare Provider Details

I. General information

NPI: 1255811469
Provider Name (Legal Business Name): TEASIA PROSISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FAIRLAND RD
SILVER SPRING MD
20904-5427
US

IV. Provider business mailing address

12420 POOLE SIDING RD
CHURCH ROAD VA
23833-2564
US

V. Phone/Fax

Practice location:
  • Phone: 434-848-4766
  • Fax:
Mailing address:
  • Phone: 804-919-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP015184A
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: