Provider Demographics
NPI:1285044412
Name:PLOMEDAHL, TERRY (PT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:PLOMEDAHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N. 10TH ST. WEST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2309
Mailing Address - Country:US
Mailing Address - Phone:715-839-9266
Mailing Address - Fax:
Practice Address - Street 1:1200 N. 10TH ST. WEST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2309
Practice Address - Country:US
Practice Address - Phone:715-839-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2374-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist