Provider Demographics
NPI:1104969120
Name:GRANT, TERESA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:19027 SILCOTT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3917
Mailing Address - Country:US
Mailing Address - Phone:540-338-1881
Mailing Address - Fax:
Practice Address - Street 1:125 HIRST RD
Practice Address - Street 2:SUITE 6A
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6000
Practice Address - Country:US
Practice Address - Phone:540-751-1970
Practice Address - Fax:540-751-1971
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050092938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist