Provider Demographics
NPI:1811390248
Name:CHRISTENSEN, TERRY LEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LEE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:CHAPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:279 E. 3RD N.
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276
Mailing Address - Country:US
Mailing Address - Phone:208-390-7216
Mailing Address - Fax:208-547-0915
Practice Address - Street 1:279 E. 3RD N.
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276
Practice Address - Country:US
Practice Address - Phone:208-390-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-192225200000X
IDMASG-168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist