Provider Demographics
NPI:1558727321
Name:DOLIN, TERESA (LMT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:DOLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MONTAGUE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986
Mailing Address - Country:US
Mailing Address - Phone:304-667-2954
Mailing Address - Fax:
Practice Address - Street 1:533 NORTH JEFFERSON STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901
Practice Address - Country:US
Practice Address - Phone:304-520-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999-0414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist