Active NPI
Lory M Teicheira, PT
- Physical Therapist
- Petaluma, CA
National Provider Identifier
1114161635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT10178
- Practice address
- 306 Bassett St
Petaluma, CA 94952-2512 - Phone
- (707) 769-0915
- Fax
- (707) 769-9244
- NPI assigned
- Apr 28, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT10178 | CA | Primary |
Addresses
Primary practice location
306 Bassett St
Petaluma, CA 94952-2512
Mailing address
306 Bassett St
Petaluma, CA 94952-2512
Phone (707) 769-0915
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT10178 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sebastopol Physical Therapy and Pilates Studio | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Sebastopol, CA
- NPI 1538201546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240876800000",
"number": "1114161635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 BASSETT ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522512",
"telephone_number": "707-769-0915",
"fax_number": "707-769-9244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 BASSETT ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522512",
"telephone_number": "707-769-0915",
"fax_number": "707-769-9244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEICHEIRA",
"first_name": "LORY",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-28",
"last_updated": "2009-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT10178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.