Provider Demographics
NPI:1598065674
Name:SPEAKS, TERRY CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:CHRISTOPHER
Last Name:SPEAKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 GALLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3711
Mailing Address - Country:US
Mailing Address - Phone:336-719-2019
Mailing Address - Fax:336-719-2019
Practice Address - Street 1:355 GALLOWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3711
Practice Address - Country:US
Practice Address - Phone:336-719-2019
Practice Address - Fax:336-719-2019
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner