Provider Demographics
NPI:1659610996
Name:TERRY, DAVID B
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:TERRY
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 1:1229 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5565
Mailing Address - Country:US
Mailing Address - Phone:772-360-8040
Mailing Address - Fax:772-299-7868
Practice Address - Street 1:2965 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3097
Practice Address - Country:US
Practice Address - Phone:772-567-8585
Practice Address - Fax:772-299-7868
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT28065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTT28065OtherSTATE OF FLORIDA