Provider Demographics
NPI:1710961040
Name:TERRY, DANA DALE (PT)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:DALE
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 1:3410 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-7502
Mailing Address - Country:US
Mailing Address - Phone:405-224-9675
Mailing Address - Fax:405-224-9677
Practice Address - Street 1:3410 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-7502
Practice Address - Country:US
Practice Address - Phone:405-222-9537
Practice Address - Fax:405-222-9566
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4536410OtherAETNA