Provider Demographics
NPI:1689872541
Name:TERRY, STEPHANIE YURICH (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:YURICH
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 1:126 MILLPORT CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5562
Mailing Address - Country:US
Mailing Address - Phone:864-329-1480
Mailing Address - Fax:864-329-8427
Practice Address - Street 1:126 MILLPORT CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5562
Practice Address - Country:US
Practice Address - Phone:864-329-1480
Practice Address - Fax:864-329-8427
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5512OtherSC LICENSE