Provider Demographics
NPI:1306233689
Name:WALBURN, TERRY E II (MSED, ATC, VATL)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:E
Last Name:WALBURN
Suffix:II
Gender:M
Credentials:MSED, ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SUPPLEJACK CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-9233
Mailing Address - Country:US
Mailing Address - Phone:757-548-5815
Mailing Address - Fax:
Practice Address - Street 1:409 SUPPLEJACK CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-9233
Practice Address - Country:US
Practice Address - Phone:757-548-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer