Basic Information
| Provider Information | |||||||||
| NPI: | 1386663664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TELLIER | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | PATRICE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16950 N BAY RD | ||||||||
| Address2: | APARTMENT #707 | ||||||||
| City: | SUNNY ISLES BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331604240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617029946 | ||||||||
| FaxNumber: | 3055850091 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 NW 12TH AVE | ||||||||
| Address2: | ROOM 146 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055856334 | ||||||||
| FaxNumber: | 3055850091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT18836 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.