Provider Demographics
NPI:1457950552
Name:FORSS, TERENCE DOUGLAS (MA, ATC, CAT(C))
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:DOUGLAS
Last Name:FORSS
Suffix:
Gender:M
Credentials:MA, ATC, CAT(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 MCCLUNG CRESCENT NW
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T6R0M8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10214-104 AVE NW
Practice Address - Street 2:#300
Practice Address - City:EDMONTON
Practice Address - State:ALBERTA
Practice Address - Zip Code:T6R0M8
Practice Address - Country:CA
Practice Address - Phone:780-499-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000373192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer