Healthcare Provider Details

I. General information

NPI: 1437707171
Provider Name (Legal Business Name): DAWN TESCHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W CLAY RD
VERSAILLES MO
65084-1177
US

IV. Provider business mailing address

18 HIGHWAY Z
ELDON MO
65026-4817
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-5411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2012025749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: