Provider Demographics
NPI:1831946110
Name:DE PAOLO-GULLION, TERRA (LMT)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:
Last Name:DE PAOLO-GULLION
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-1427
Mailing Address - Country:US
Mailing Address - Phone:765-810-7381
Mailing Address - Fax:
Practice Address - Street 1:9212 W SMITH ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-1225
Practice Address - Country:US
Practice Address - Phone:765-729-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22408225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist