Provider Demographics
NPI:1700862950
Name:JOLLIFF, TERRY L (MPT)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:JOLLIFF
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1345
Mailing Address - Country:US
Mailing Address - Phone:419-422-5526
Mailing Address - Fax:419-422-5562
Practice Address - Street 1:1069 KLOTZ RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4820
Practice Address - Country:US
Practice Address - Phone:419-728-7019
Practice Address - Fax:419-728-7020
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1442035OtherBWC
OH2495590Medicaid
OH9313985Medicare PIN