Provider Demographics
NPI:1386159895
Name:ELDENBURG, TERI (PT)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:ELDENBURG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:RENE
Other - Last Name:BAUGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80520-1035
Mailing Address - Country:US
Mailing Address - Phone:530-864-1687
Mailing Address - Fax:
Practice Address - Street 1:231 FIRST ST
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80520-1035
Practice Address - Country:US
Practice Address - Phone:530-864-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251G0304X
MD17446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics