Healthcare Provider Details

I. General information

NPI: 1720109804
Provider Name (Legal Business Name): TERESA J PESCI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

10691 MARCELLA AVE
SOUTH LYON MI
48178-0020
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9611
  • Fax:
Mailing address:
  • Phone: 410-949-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501009694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: