Provider Demographics
NPI:1356509814
Name:TERRY, CURTIS WAYNE (PTA)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:WAYNE
Last Name:TERRY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 VELVET ANTLER DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1918
Mailing Address - Country:US
Mailing Address - Phone:804-739-6562
Mailing Address - Fax:
Practice Address - Street 1:7530 VELVET ANTLER DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1918
Practice Address - Country:US
Practice Address - Phone:804-739-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001057225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant