Provider Demographics
NPI:1912956244
Name:TERLAJE, ALFRED J (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:J
Last Name:TERLAJE
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 KAPLAN WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4896
Mailing Address - Country:US
Mailing Address - Phone:919-570-0104
Mailing Address - Fax:
Practice Address - Street 1:2709 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-784-4696
Practice Address - Fax:919-784-4697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8782225100000X
WA5485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078X5Medicare UPIN