Provider Demographics
NPI:1508215351
Name:STEVEN, TERRY GLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:GLEN
Last Name:STEVEN
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 1:2540 BRINLEY DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5136
Mailing Address - Country:US
Mailing Address - Phone:813-748-4499
Mailing Address - Fax:
Practice Address - Street 1:4927 VOORHEES RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5542
Practice Address - Country:US
Practice Address - Phone:727-848-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist