Provider Demographics
NPI:1760563605
Name:TERRY, ONUWA D (LPT,DPT)
Entity Type:Individual
Prefix:MR
First Name:ONUWA
Middle Name:D
Last Name:TERRY
Suffix:
Gender:M
Credentials:LPT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E GRIFFIN PKWY PMB 184
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3180
Mailing Address - Country:US
Mailing Address - Phone:956-583-2995
Mailing Address - Fax:956-583-3595
Practice Address - Street 1:1918 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-583-2995
Practice Address - Fax:956-583-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108207261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087750801Medicaid
TXS86483Medicare UPIN
1760563605Medicare PIN