Provider Demographics
NPI:1568823250
Name:CRUM, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:CRUM
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 1:501 FLATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEW JOHNSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37134-2159
Mailing Address - Country:US
Mailing Address - Phone:931-209-5379
Mailing Address - Fax:931-535-2747
Practice Address - Street 1:501 FLATWOOD RD
Practice Address - Street 2:
Practice Address - City:NEW JOHNSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37134-2159
Practice Address - Country:US
Practice Address - Phone:931-209-5379
Practice Address - Fax:931-535-2747
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006490173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist