Healthcare Provider Details

I. General information

NPI: 1982645834
Provider Name (Legal Business Name): CHRISTY DIANE TEICHELMAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 W HWY 84 CROSSROADS WEST #404
WACO TX
76612
US

IV. Provider business mailing address

8810 W HWY 84 CROSSROADS WEST #404
WACO TX
76612
US

V. Phone/Fax

Practice location:
  • Phone: 254-776-1739
  • Fax: 254-776-1578
Mailing address:
  • Phone: 254-776-1739
  • Fax: 254-776-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1141661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: