Provider Demographics
NPI:1730493842
Name:MABERRY, TERRI DIANE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:DIANE
Last Name:MABERRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:MABERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949-0615
Mailing Address - Country:US
Mailing Address - Phone:936-676-0352
Mailing Address - Fax:
Practice Address - Street 1:5459 HWY 59 N
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-8531
Practice Address - Country:US
Practice Address - Phone:936-676-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT028461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist