Provider Demographics
NPI:1689964868
Name:TERRY, TERRI (LCMT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12829 JEFFERSON AVE
Mailing Address - Street 2:106A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3057
Mailing Address - Country:US
Mailing Address - Phone:757-344-1357
Mailing Address - Fax:
Practice Address - Street 1:12829 JEFFERSON AVE
Practice Address - Street 2:106A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3057
Practice Address - Country:US
Practice Address - Phone:757-344-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007068173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist