Provider Demographics
NPI:1174698013
Name:TEERING, MARIO (PT)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:TEERING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 DAVID AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5508
Mailing Address - Country:US
Mailing Address - Phone:831-333-1187
Mailing Address - Fax:831-333-1187
Practice Address - Street 1:505 E ROMIE LN STE I
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4031
Practice Address - Country:US
Practice Address - Phone:831-757-3055
Practice Address - Fax:831-757-5622
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT16753Medicare ID - Type Unspecified