Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1360 | AL |
NPI | 1073690640 |
---|---|
Provider Name | Mr. Terry A. Meharry |
First Address | Tuscaloosa, AL 35401-2010 |
Second Address | Tuscaloosa, AL 35401-2010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R36970 | (02) | AL |