Provider Demographics
NPI:1649632894
Name:TERRELL, JAMES M JR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:TERRELL
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MOLL RD
Mailing Address - Street 2:
Mailing Address - City:SUNFLOWER
Mailing Address - State:MS
Mailing Address - Zip Code:38778-9744
Mailing Address - Country:US
Mailing Address - Phone:662-207-8153
Mailing Address - Fax:
Practice Address - Street 1:23 MOLL RD
Practice Address - Street 2:
Practice Address - City:SUNFLOWER
Practice Address - State:MS
Practice Address - Zip Code:38778-9744
Practice Address - Country:US
Practice Address - Phone:662-207-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1713171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor