Provider Demographics
NPI:1225466956
Name:TERRY, STEPHEN DANIEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DANIEL
Last Name:TERRY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:DANIEL
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:37699 6 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2695
Mailing Address - Country:US
Mailing Address - Phone:734-953-4155
Mailing Address - Fax:734-953-1622
Practice Address - Street 1:37699 6 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2695
Practice Address - Country:US
Practice Address - Phone:734-953-4155
Practice Address - Fax:734-953-1622
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N26120Medicare UPIN