Provider Demographics
NPI:1699493106
Name:LOUER, TERESIA COHEN (ITDS)
Entity type:Individual
Prefix:
First Name:TERESIA
Middle Name:COHEN
Last Name:LOUER
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11751 SW VIRIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-6920
Mailing Address - Country:US
Mailing Address - Phone:916-458-1369
Mailing Address - Fax:
Practice Address - Street 1:11751 SW VIRIDIAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-6920
Practice Address - Country:US
Practice Address - Phone:916-458-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist