Provider Demographics
NPI:1275969958
Name:ISHMAEL, TERRA LINDA
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:LINDA
Last Name:ISHMAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3849
Mailing Address - Country:US
Mailing Address - Phone:702-203-6553
Mailing Address - Fax:708-822-1124
Practice Address - Street 1:224 S. JONES
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:702-822-1206
Practice Address - Fax:702-822-1124
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner