Provider Demographics
NPI:1063697878
Name:SMITH, TERYLYN DENISE (LPT)
Entity type:Individual
Prefix:MRS
First Name:TERYLYN
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13800 HEACOCK ST
Mailing Address - Street 2:STE. C236
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3339
Mailing Address - Country:US
Mailing Address - Phone:951-653-0819
Mailing Address - Fax:951-465-3203
Practice Address - Street 1:13800 HEACOCK ST
Practice Address - Street 2:STE. C236
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3339
Practice Address - Country:US
Practice Address - Phone:951-653-0819
Practice Address - Fax:951-656-2614
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner