Provider Demographics
NPI:1780877886
Name:TERRY, DAVID BRIAN (DPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:TERRY
Suffix:
Gender:M
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:904-261-4664
Mailing Address - Fax:904-261-5852
Practice Address - Street 1:1897 ISLAND WALK WAY STE 5
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1949
Practice Address - Country:US
Practice Address - Phone:904-261-4664
Practice Address - Fax:904-261-5852
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist