Provider Demographics
NPI:1194235598
Name:GINGLES, TERESA SEBASTIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:SEBASTIAN
Last Name:GINGLES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N VALLEY MILLS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4425
Mailing Address - Country:US
Mailing Address - Phone:254-203-5040
Mailing Address - Fax:
Practice Address - Street 1:1107 N VALLEY MILLS DR STE 103
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4425
Practice Address - Country:US
Practice Address - Phone:254-203-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12053702251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics