Provider Demographics
NPI:1609935477
Name:TERRY REHABILITATION & TESTING
Entity Type:Organization
Organization Name:TERRY REHABILITATION & TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:972-939-6501
Mailing Address - Street 1:PO BOX 117213
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-7213
Mailing Address - Country:US
Mailing Address - Phone:972-939-6501
Mailing Address - Fax:866-451-0585
Practice Address - Street 1:1428 W HEBRON PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6345
Practice Address - Country:US
Practice Address - Phone:972-939-6501
Practice Address - Fax:866-451-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3290OtherBLUE CROSS BLUE SHIELD
TX10035116OtherAMERIGROUP
TX173756101Medicaid
TX10035116OtherAMERIGROUP