Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1169937 | TX |
NPI | 1003009929 |
---|---|
Provider Name | Mrs. Michelle Mundy Teague |
First Address | Allen, TX 75013-6400 |
Second Address | Allen, TX 75013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 21/08/2019 |