Provider Demographics
NPI:1437027703
Name:TEITELBAUM, ALEX (CPO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10241 KINGSTON PIKE STE 4
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3240
Mailing Address - Country:US
Mailing Address - Phone:865-672-6740
Mailing Address - Fax:865-672-6741
Practice Address - Street 1:10241 KINGSTON PIKE STE 4
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3240
Practice Address - Country:US
Practice Address - Phone:865-672-6740
Practice Address - Fax:865-672-6741
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13276220222Z00000X
TN13276223224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist