Provider Demographics
NPI:1225435191
Name:WISHON, TERRA (DPT)
Entity Type:Individual
Prefix:DR
First Name:TERRA
Middle Name:
Last Name:WISHON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 PENNSYLVANIA ST
Mailing Address - Street 2:UNIT 4536
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1331
Mailing Address - Country:US
Mailing Address - Phone:303-602-1586
Mailing Address - Fax:
Practice Address - Street 1:780 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4532
Practice Address - Country:US
Practice Address - Phone:303-602-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist