Provider Demographics
NPI:1144608688
Name:TERILLI, PETER (PT, DPT ATC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TERILLI
Suffix:
Gender:M
Credentials:PT, DPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAIN ST SUITE 1,
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720
Mailing Address - Country:US
Mailing Address - Phone:585-730-0913
Mailing Address - Fax:
Practice Address - Street 1:268 PELICAN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3040
Practice Address - Country:US
Practice Address - Phone:585-730-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01684000225100000X
NY0022142255A2300X
NJ25MT002216002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer