Provider Demographics
NPI:1770130338
Name:ERDNER, TERRA (DPT)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:ERDNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FOX LAIR TRL
Mailing Address - Street 2:
Mailing Address - City:SEMORA
Mailing Address - State:NC
Mailing Address - Zip Code:27343-7154
Mailing Address - Country:US
Mailing Address - Phone:336-213-9757
Mailing Address - Fax:
Practice Address - Street 1:350 FOX LAIR TRL
Practice Address - Street 2:
Practice Address - City:SEMORA
Practice Address - State:NC
Practice Address - Zip Code:27343-7154
Practice Address - Country:US
Practice Address - Phone:336-213-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist