Provider Demographics
NPI:1639131071
Name:GEIRNAEIRT, TERRY LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:GEIRNAEIRT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1104
Mailing Address - Country:US
Mailing Address - Phone:217-245-3397
Mailing Address - Fax:217-245-3398
Practice Address - Street 1:1101 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2212
Practice Address - Country:US
Practice Address - Phone:217-245-3397
Practice Address - Fax:217-245-3398
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer