Provider Demographics
NPI:1538577903
Name:TEAGUE, EDDIE (PT)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2509
Mailing Address - Country:US
Mailing Address - Phone:361-551-2513
Mailing Address - Fax:361-551-2528
Practice Address - Street 1:1300 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2509
Practice Address - Country:US
Practice Address - Phone:361-551-2513
Practice Address - Fax:361-551-2528
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-6859-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist