Provider Demographics
NPI:1285877167
Name:TEALL, LESSIE RAE (PT)
Entity type:Individual
Prefix:
First Name:LESSIE
Middle Name:RAE
Last Name:TEALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 KENDALL RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9200
Mailing Address - Country:US
Mailing Address - Phone:614-798-0823
Mailing Address - Fax:
Practice Address - Street 1:6250 KENDALL RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9200
Practice Address - Country:US
Practice Address - Phone:614-798-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist