Provider Demographics
NPI:1366722894
Name:HOUGHTON, THERESA LEE (PTA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LEE
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1113
Mailing Address - Country:US
Mailing Address - Phone:585-591-2096
Mailing Address - Fax:
Practice Address - Street 1:29 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1113
Practice Address - Country:US
Practice Address - Phone:585-591-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004546-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant