Healthcare Provider Details

I. General information

NPI: 1346901550
Provider Name (Legal Business Name): JENNIFER MARIE TESLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 100TH ST SW STE B
LAKEWOOD WA
98499-2710
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 253-284-9800
  • Fax:
Mailing address:
  • Phone: 866-370-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH10657
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: