Provider Demographics
NPI:1366541476
Name:TERESA VITALE,P.T. LLC
Entity type:Organization
Organization Name:TERESA VITALE,P.T. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-463-6606
Mailing Address - Street 1:17280 BUCKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1412
Mailing Address - Country:US
Mailing Address - Phone:440-463-6606
Mailing Address - Fax:440-543-5120
Practice Address - Street 1:17280 BUCKTHORN DR
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-1412
Practice Address - Country:US
Practice Address - Phone:440-463-6606
Practice Address - Fax:440-543-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP T 08117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVI14129031Medicare UPIN
OHTE9343051Medicare UPIN