Healthcare Provider Details

I. General information

NPI: 1295987220
Provider Name (Legal Business Name): CYNTHIA MARIE TESKE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 HERITAGE BLVD
WEST SALEM WI
54669-1417
US

IV. Provider business mailing address

1540 HERITAGE BLVD
WEST SALEM WI
54669-1417
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-4989
  • Fax: 608-786-2321
Mailing address:
  • Phone: 608-786-4989
  • Fax: 608-786-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number3576-024
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3576-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: