Basic Information
| Provider Information | |||||||||
| NPI: | 1588604771 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TELETCHEA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20684 JOHN J WILLIAMS HWY STE 2 | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199584393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029450200 | ||||||||
| FaxNumber: | 3029456959 | ||||||||
| Practice Location | |||||||||
| Address1: | 20684 JOHN J WILLIAMS HWY STE 2 | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199584393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029450200 | ||||||||
| FaxNumber: | 3029456959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 21176 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | J1-0002210 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.