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NPI Code Detail

MEDICARE: MARY K TELETCHEA MSPT

MEDICARE: MARY K TELETCHEA MSPT
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
1225100000XPhysical Therapist4782SC

General Provider Information

NPI Number : 1588604771
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY K TELETCHEA MSPT
Provider Business Mailing Address
First Line : 210 VILLAGE CENTER BLVD STE 140
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-6706
Country : US
Telephone Number : 843-353-3460
Fax Number : 843-353-3461
Provider Business Practice Location Address
First Line : 1621 HIGHWAY 17 N
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-2229
Country : US
Telephone Number : 843-353-3460
Fax Number : 843-353-3461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 01/06/2025

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Directions to “ MARY K TELETCHEA MSPT” Practice Location

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