Provider Demographics
NPI:1821546250
Name:TERRELONGE, CHARITY MICHELLE (PT-DPT)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:MICHELLE
Last Name:TERRELONGE
Suffix:
Gender:F
Credentials:PT-DPT
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:MICHELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2166
Mailing Address - Country:US
Mailing Address - Phone:770-978-5328
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL WAY STE 150
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2166
Practice Address - Country:US
Practice Address - Phone:770-978-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1279111225100000X
GAPT013360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist