Provider Demographics
NPI:1174740369
Name:SYPERRECK, TERESA A (CMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:SYPERRECK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8518
Mailing Address - Country:US
Mailing Address - Phone:970-243-5853
Mailing Address - Fax:
Practice Address - Street 1:2532 F RD
Practice Address - Street 2:SUITE 15
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1099
Practice Address - Country:US
Practice Address - Phone:970-254-2954
Practice Address - Fax:970-254-2958
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist