Provider Demographics
NPI:1043583859
Name:TERRIL, AMBER (MT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:TERRIL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10551 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5737
Mailing Address - Country:US
Mailing Address - Phone:952-435-5300
Mailing Address - Fax:952-898-1454
Practice Address - Street 1:10551 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5737
Practice Address - Country:US
Practice Address - Phone:952-435-5300
Practice Address - Fax:952-898-1454
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist