Provider Demographics
NPI:1275119646
Name:TERRY, VICTORIA (MPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 GOGUAC ST W STE B2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49015-2097
Mailing Address - Country:US
Mailing Address - Phone:269-223-7786
Mailing Address - Fax:
Practice Address - Street 1:777 GOGUAC ST W STE B2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49015-2097
Practice Address - Country:US
Practice Address - Phone:269-223-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics