Healthcare Provider Details

I. General information

NPI: 1093924235
Provider Name (Legal Business Name): TERESA ANN BRIEDWELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CLUB VILLAGE DR STE 103
COLUMBIA MO
65203-4411
US

IV. Provider business mailing address

7601 E ROSADENE LN
COLUMBIA MO
65201-9652
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-2777
  • Fax: 573-256-2764
Mailing address:
  • Phone: 573-817-3257
  • Fax: 573-256-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01133
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: