Provider Demographics
NPI:1619355153
Name:TEBBS, ALI (DPT, PT)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:TEBBS
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:RIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:1281 9TH AVE
Mailing Address - Street 2:UNIT 2012
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4633
Mailing Address - Country:US
Mailing Address - Phone:706-405-0705
Mailing Address - Fax:
Practice Address - Street 1:1281 9TH AVE
Practice Address - Street 2:UNIT 2012
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4633
Practice Address - Country:US
Practice Address - Phone:706-405-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42092225100000X
GAPT0116016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist