Individual
AUTUMN TEESDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15311 VANTAGE PKWY W, STE 130, HOUSTON, TX 77032-1954
(281) 442-6861
Mailing address
2111 TRAILING VINE RD, SPRING, TX 77373-6475
(713) 398-4553
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051797
LICENSE#
TX
Enumeration date
08/30/2006
Last updated
07/08/2007
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