Provider Demographics
NPI:1407162977
Name:TERRY, VANESSA ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ANN
Last Name:TERRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8415
Mailing Address - Country:US
Mailing Address - Phone:606-831-8103
Mailing Address - Fax:
Practice Address - Street 1:1018 6TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2308
Practice Address - Country:US
Practice Address - Phone:304-522-1155
Practice Address - Fax:304-522-1160
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-2071Medicaid