MEDICARE: TERESA LAVERIE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	014396	NY

General Provider Information

NPI Number	:	1255152880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LAVERIE PTA

Provider Business Mailing Address
First Line	:	19 MIDLAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2425
Country	:	US
Telephone Number	:	917-743-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2338
Country	:	US
Telephone Number	:	718-943-9830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “ TERESA LAVERIE PTA” Practice Location

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