Provider Demographics
NPI:1003092586
Name:TERRY, JENNIFER MICHELLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:STREEPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:11812 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1528
Mailing Address - Country:US
Mailing Address - Phone:813-857-7800
Mailing Address - Fax:813-988-5837
Practice Address - Street 1:11812 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1528
Practice Address - Country:US
Practice Address - Phone:813-857-7800
Practice Address - Fax:813-988-5837
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist