Provider Demographics
NPI:1922263805
Name:EDWARDS, TERRANCE MONTRAL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:MONTRAL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W FERTITTA BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4666
Mailing Address - Country:US
Mailing Address - Phone:337-238-9931
Mailing Address - Fax:337-239-0066
Practice Address - Street 1:414 N PLANT AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563
Practice Address - Country:US
Practice Address - Phone:813-707-9362
Practice Address - Fax:813-757-9687
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07348225100000X
NC12476225100000X
FL27002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT27002OtherSTATE LICENSE