Provider Demographics
NPI:1033732029
Name:TERRELL, ANTONIO WAYNE (PERSONAL TRAINER)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:WAYNE
Last Name:TERRELL
Suffix:
Gender:M
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-2845
Mailing Address - Country:US
Mailing Address - Phone:502-552-9163
Mailing Address - Fax:
Practice Address - Street 1:3813 PARKER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-2845
Practice Address - Country:US
Practice Address - Phone:502-552-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer