Provider Demographics
NPI:1972699130
Name:MORNEAULT, TERESA BEAN (PT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:BEAN
Last Name:MORNEAULT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1722
Mailing Address - Country:US
Mailing Address - Phone:706-546-1333
Mailing Address - Fax:706-546-5807
Practice Address - Street 1:108 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1722
Practice Address - Country:US
Practice Address - Phone:706-546-1333
Practice Address - Fax:706-546-5807
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0080252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA008025OtherPHYSICAL THERAPIST LICENS
GA008025OtherPHYSICAL THERAPIST LICENS
65BBDLFMedicare ID - Type Unspecified