Basic Information
| Provider Information | |||||||||
| NPI: | 1902387798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESPEJON | ||||||||
| FirstName: | TEDDY LESANDRO | ||||||||
| MiddleName: | CHUA | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2235 TREASURE MOUNTAIN DR | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773884863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6824593433 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 LANTERN BEND DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770902832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322496500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2018 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1197959 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.