Provider Demographics
NPI:1356647671
Name:MCLAIN, TERRY JOSEPH (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:JOSEPH
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROOM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-1530
Mailing Address - Country:US
Mailing Address - Phone:352-593-4059
Mailing Address - Fax:
Practice Address - Street 1:20 CROOM RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-1530
Practice Address - Country:US
Practice Address - Phone:352-593-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0020940225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist