Provider Demographics
NPI:1326668740
Name:EDWARDS, TERRY LYNN (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 DOTSERO CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3070
Mailing Address - Country:US
Mailing Address - Phone:970-203-4983
Mailing Address - Fax:
Practice Address - Street 1:2527 DOTSERO CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3070
Practice Address - Country:US
Practice Address - Phone:970-203-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002824261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy