Provider Demographics
NPI:1124024823
Name:TERRY, JOANN M (PT)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:M
Last Name:TERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JO
Other - Middle Name:M
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:6223 MAPLE RIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-4441
Mailing Address - Country:US
Mailing Address - Phone:859-431-5779
Mailing Address - Fax:
Practice Address - Street 1:1400 GLORIA TERRELL DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076-9189
Practice Address - Country:US
Practice Address - Phone:859-781-2800
Practice Address - Fax:859-781-3500
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001310208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700148300Medicaid
KY5017101Medicare PIN
KYR62156Medicare UPIN
KY0667002Medicare PIN