Provider Demographics
NPI:1528209202
Name:DESPOT, TERRENCE JOSEPH (PTA)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:JOSEPH
Last Name:DESPOT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1905
Mailing Address - Country:US
Mailing Address - Phone:276-666-4510
Mailing Address - Fax:276-632-6884
Practice Address - Street 1:3 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1905
Practice Address - Country:US
Practice Address - Phone:276-666-4510
Practice Address - Fax:276-632-6884
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000628225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant