Provider Demographics
NPI:1346516440
Name:REUBEN, TERENCE RODERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:RODERICK
Last Name:REUBEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SHERWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5010
Mailing Address - Country:US
Mailing Address - Phone:616-901-3831
Mailing Address - Fax:
Practice Address - Street 1:1540 SHERWOOD AVE SE
Practice Address - Street 2:
Practice Address - City:EAST GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-5010
Practice Address - Country:US
Practice Address - Phone:616-901-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist