Provider Demographics
NPI:1205880119
Name:TERRELL, JEFFREY A (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:TERRELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 DECATUR HWY
Mailing Address - Street 2:SUITE 123
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2301
Mailing Address - Country:US
Mailing Address - Phone:205-418-1200
Mailing Address - Fax:205-418-1210
Practice Address - Street 1:2217 DECATUR HWY
Practice Address - Street 2:SUITE 123
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2301
Practice Address - Country:US
Practice Address - Phone:205-418-1200
Practice Address - Fax:205-418-1210
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531652Medicaid
AL6400005OtherUNITED HEALTHCARE
AL051531652OtherBLUE CROSS & BLUE SHIELD
AL051531652Medicaid
AL051531652OtherBLUE CROSS & BLUE SHIELD