Provider Demographics
NPI:1538228903
Name:NEGEN, TERESA (LPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:NEGEN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50619-2022
Mailing Address - Country:US
Mailing Address - Phone:319-278-4321
Mailing Address - Fax:319-278-4323
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IA
Practice Address - Zip Code:50619-2022
Practice Address - Country:US
Practice Address - Phone:319-278-4321
Practice Address - Fax:319-278-4323
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist