Provider Demographics
NPI:1447254271
Name:PEPERA, TERESA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:PEPERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4564 ASHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8181
Mailing Address - Country:US
Mailing Address - Phone:614-219-7479
Mailing Address - Fax:614-219-7480
Practice Address - Street 1:4555 CEMETERY RD STE C
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1102
Practice Address - Country:US
Practice Address - Phone:614-219-7479
Practice Address - Fax:614-219-7480
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-04476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHIN9370711OtherMEDICARE PTAN
PE4217802OtherMEDICARE PTAN