Provider Demographics
NPI:1740569375
Name:MUNOZ, TERRI (LMBT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 VILLAGE DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7067
Mailing Address - Country:US
Mailing Address - Phone:910-545-7698
Mailing Address - Fax:
Practice Address - Street 1:99 VILLAGE DR
Practice Address - Street 2:SUITE 14
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7067
Practice Address - Country:US
Practice Address - Phone:910-545-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist