Provider Demographics
NPI:1811227366
Name:MCCANN, TERRY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:MARIE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:MARIE
Other - Last Name:HEFFERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17 CHIPMAN WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364
Mailing Address - Country:US
Mailing Address - Phone:781-336-5107
Mailing Address - Fax:
Practice Address - Street 1:17 CHIPMAN WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364
Practice Address - Country:US
Practice Address - Phone:781-336-5107
Practice Address - Fax:978-388-8255
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist