Provider Demographics
NPI:1972658763
Name:MCMAINS, TERRI ANN (PT,DPT)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:ANN
Last Name:MCMAINS
Suffix:
Gender:F
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:PO BOX 57
Mailing Address - Street 2:53 WEST PALO ALTO AVENUE
Mailing Address - City:OCOTILLO
Mailing Address - State:CA
Mailing Address - Zip Code:92259
Mailing Address - Country:US
Mailing Address - Phone:760-554-1244
Mailing Address - Fax:
Practice Address - Street 1:1528 S WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4142
Practice Address - Country:US
Practice Address - Phone:760-554-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80472251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 8074Medicare PIN