Provider Demographics
NPI:1184625170
Name:LONGENECKER, TERRY L (PT)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:LONGENECKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MEDICAL STAFF OFFICE
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2041
Mailing Address - Fax:717-747-2102
Practice Address - Street 1:1855 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-848-4800
Practice Address - Fax:717-741-4240
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005109L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACK4276OtherPALMETTO GBA RR MEDICARE
PA177124OtherMEDICARE HGS ADMINISTRATO
PA03182100OtherCAPITAL BLUE CROSS
PA18444OtherHEALTH AMERICA
PA332313OtherHIGHMARK BLUE SHIELD
PA0068377000OtherAMERIHEALTH UNDER IBC
PA0197900001Medicare NSC