Provider Demographics
NPI:1467510834
Name:TERRY, CATHY DIANE (CLMT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:DIANE
Last Name:TERRY
Suffix:
Gender:F
Credentials:CLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4868 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2048
Mailing Address - Country:US
Mailing Address - Phone:402-331-0392
Mailing Address - Fax:402-331-0183
Practice Address - Street 1:MUSCULAR THERAPY CLINIC 4868 S. 96TH ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2048
Practice Address - Country:US
Practice Address - Phone:402-331-0392
Practice Address - Fax:402-331-0183
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist