Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT16855 | FL |
NPI | 1003092586 |
---|---|
Provider Name | Mrs. Jennifer Michelle Terry |
First Address | Tampa, FL 33617-1528 |
Second Address | Tampa, FL 33617-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 15/01/2008 |