Provider Demographics
NPI:1851013767
Name:ECHOLS, TERRY LEE
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:ECHOLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 WHITE KNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT NEBO
Mailing Address - State:WV
Mailing Address - Zip Code:26679-8083
Mailing Address - Country:US
Mailing Address - Phone:304-619-9494
Mailing Address - Fax:
Practice Address - Street 1:377 WHITE KNIGHT LN
Practice Address - Street 2:
Practice Address - City:MOUNT NEBO
Practice Address - State:WV
Practice Address - Zip Code:26679-8083
Practice Address - Country:US
Practice Address - Phone:304-619-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002173225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty