Provider Demographics
NPI:1023006137
Name:TERRY, STEPHENIA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHENIA
Middle Name:D
Last Name:TERRY
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 1:1441 HIGHWAY 62-412
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542
Mailing Address - Country:US
Mailing Address - Phone:870-856-9675
Mailing Address - Fax:870-856-9679
Practice Address - Street 1:1441 HIGHWAY 62-412
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:AR
Practice Address - Zip Code:72542
Practice Address - Country:US
Practice Address - Phone:870-856-9675
Practice Address - Fax:870-856-9679
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134409721Medicaid
AR5X069OtherARKANSAS BLUE CROSS
AR5X069Medicare ID - Type Unspecified