Provider Demographics
NPI:1225475668
Name:TERRY, MICHAEL JOSEPH (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TERRY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 E 100 N STE 1
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2600
Mailing Address - Country:US
Mailing Address - Phone:435-613-1500
Mailing Address - Fax:435-613-1501
Practice Address - Street 1:590 E 100 N STE 1
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2600
Practice Address - Country:US
Practice Address - Phone:435-613-1500
Practice Address - Fax:435-613-1501
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8570958-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic