Provider Demographics
NPI:1346451416
Name:TERPSTRA, MELISSA LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEIGH
Last Name:TERPSTRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SPRINGCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7306
Mailing Address - Country:US
Mailing Address - Phone:803-746-4655
Mailing Address - Fax:803-746-7807
Practice Address - Street 1:206 SPRINGCREST DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7306
Practice Address - Country:US
Practice Address - Phone:803-746-4655
Practice Address - Fax:803-746-7807
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32072225100000X
SC6687225100000X
NC13640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6687OtherSTATE OF SOUTH CAROLINA, DEPARTMENT OF LABOR, LICENSING AND REGULATION
NC13640OtherNORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS
CA32072OtherLICENSE