Provider Demographics
NPI:1215052923
Name:DAVIS, TERRY LYNN (PT)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 STATE HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-9144
Mailing Address - Country:US
Mailing Address - Phone:573-282-4949
Mailing Address - Fax:573-208-4219
Practice Address - Street 1:201 STATE HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-9144
Practice Address - Country:US
Practice Address - Phone:573-282-4949
Practice Address - Fax:573-208-4219
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101399225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic