Provider Demographics
NPI:1689217689
Name:TERRY, JENNIFER CLARKE (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLARKE
Last Name:TERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 S 250 E STE 170
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8107
Mailing Address - Country:US
Mailing Address - Phone:801-314-5200
Mailing Address - Fax:801-314-5201
Practice Address - Street 1:5770 S 250 E STE 170
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8107
Practice Address - Country:US
Practice Address - Phone:801-314-5200
Practice Address - Fax:801-314-5201
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT265572-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist