Provider Demographics
NPI:1497076244
Name:TERRY, RICHMOND BOHLER III (L M T)
Entity Type:Individual
Prefix:MR
First Name:RICHMOND
Middle Name:BOHLER
Last Name:TERRY
Suffix:III
Gender:M
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 MOORES MILL DR
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-2165
Mailing Address - Country:US
Mailing Address - Phone:423-316-3665
Mailing Address - Fax:
Practice Address - Street 1:118 N ROSS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4857
Practice Address - Country:US
Practice Address - Phone:334-826-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist