Provider Demographics
NPI:1356470306
Name:SCHLEGEL, TERRI SUZANNE (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:SUZANNE
Last Name:SCHLEGEL
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:SUZANNE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:120 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1819
Mailing Address - Country:US
Mailing Address - Phone:631-473-1192
Mailing Address - Fax:
Practice Address - Street 1:120 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1819
Practice Address - Country:US
Practice Address - Phone:631-473-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022515-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist