Provider Demographics
NPI:1568936979
Name:SORY, TERRI (MPA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:SORY
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1043
Mailing Address - Country:US
Mailing Address - Phone:801-525-4968
Mailing Address - Fax:
Practice Address - Street 1:22 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1043
Practice Address - Country:US
Practice Address - Phone:801-525-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator