Provider Demographics
NPI:1619161296
Name:TERRELL, TOCQUIN PAXTON (PTA)
Entity Type:Individual
Prefix:
First Name:TOCQUIN
Middle Name:PAXTON
Last Name:TERRELL
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 1:41 N HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-4321
Mailing Address - Country:US
Mailing Address - Phone:803-422-6486
Mailing Address - Fax:
Practice Address - Street 1:146 BATTLESHIP RD
Practice Address - Street 2:SPRINGDALE HEALTHCARE CENTER
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2060
Practice Address - Country:US
Practice Address - Phone:803-432-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2124225200000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility