Provider Demographics
NPI:1235599119
Name:TERRELL, DANIEL B (PT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:B
Last Name:TERRELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ROOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2420
Mailing Address - Country:US
Mailing Address - Phone:970-242-0111
Mailing Address - Fax:970-263-4334
Practice Address - Street 1:321 ROOD AVE
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81501-2420
Practice Address - Country:US
Practice Address - Phone:970-242-0111
Practice Address - Fax:970-263-4334
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist