Provider Demographics
NPI:1336819580
Name:DODDS, TERRA MAY (MPT)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:MAY
Last Name:DODDS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:LYNN
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12757 RAMBLER RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7906
Mailing Address - Country:US
Mailing Address - Phone:517-331-3913
Mailing Address - Fax:
Practice Address - Street 1:1013 S US HIGHWAY 27 STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2423
Practice Address - Country:US
Practice Address - Phone:989-224-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010097652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics