Basic Information
| Provider Information | |||||||||
| NPI: | 1003009929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEAGUE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MUNDY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1223 W MCDERMOTT DR STE 50 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750136400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723591288 | ||||||||
| FaxNumber: | 9723599652 | ||||||||
| Practice Location | |||||||||
| Address1: | 1223 W MCDERMOTT DR STE 50 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723591288 | ||||||||
| FaxNumber: | 9723599652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1169937 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.