Provider Demographics
NPI:1356648851
Name:TERRILL, BRIAN L (NCTMB, CMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:TERRILL
Suffix:
Gender:M
Credentials:NCTMB, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21282 HEDGEROW TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5441
Mailing Address - Country:US
Mailing Address - Phone:703-554-4908
Mailing Address - Fax:703-738-7053
Practice Address - Street 1:21282 HEDGEROW TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5441
Practice Address - Country:US
Practice Address - Phone:703-554-4908
Practice Address - Fax:703-738-7053
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006890172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist