Provider Demographics
NPI:1588915516
Name:EHRIE, TEELA M (PT)
Entity type:Individual
Prefix:
First Name:TEELA
Middle Name:M
Last Name:EHRIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TEELA
Other - Middle Name:M
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:14641 THATCHER LN # 17
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1577
Practice Address - Country:US
Practice Address - Phone:317-819-6080
Practice Address - Fax:317-815-5933
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010960A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM155585002Medicare PIN