Provider Demographics
NPI:1104048800
Name:TERRY, ANGIE M (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:M
Last Name:TERRY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2176
Mailing Address - Country:US
Mailing Address - Phone:334-792-5796
Mailing Address - Fax:
Practice Address - Street 1:123 S PAINTER AVE STE C
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-1802
Practice Address - Country:US
Practice Address - Phone:334-774-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist