Provider Demographics
NPI:1184938318
Name:TRAUT, TERESA (PT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TRAUT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1361
Mailing Address - Country:US
Mailing Address - Phone:706-705-1252
Mailing Address - Fax:
Practice Address - Street 1:1061 SOUTHWIND DR
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:GA
Practice Address - Zip Code:30621-1361
Practice Address - Country:US
Practice Address - Phone:706-705-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT009833OtherSTATE LICENSE