Provider Demographics
NPI:1407337298
Name:BARBOUR, TERRI L
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13280 MARTINSVILLE HWY LOT 39
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:VA
Mailing Address - Zip Code:24069-3549
Mailing Address - Country:US
Mailing Address - Phone:434-713-3315
Mailing Address - Fax:
Practice Address - Street 1:13280 MARTINSVILLE HWY LOT 39
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:VA
Practice Address - Zip Code:24069-3549
Practice Address - Country:US
Practice Address - Phone:434-713-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA83-1732325Medicaid