Provider Demographics
NPI:1235808239
Name:JUSTICE, TERRY LEE
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-3763
Mailing Address - Country:US
Mailing Address - Phone:937-214-2472
Mailing Address - Fax:
Practice Address - Street 1:609 WEBER ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-3763
Practice Address - Country:US
Practice Address - Phone:937-214-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide