Basic Information
| Provider Information | |||||||||
| NPI: | 1720109804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PESCI | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10691 MARCELLA AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH LYON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481780020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109497865 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2636 S MILFORD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483574938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486849611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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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 | 2251P0200X | 5501009694 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.