Provider Demographics
NPI:1316095177
Name:ETHER, TERRY (CPO)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:ETHER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 LAKE WOODARD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3659
Mailing Address - Country:US
Mailing Address - Phone:919-231-6890
Mailing Address - Fax:919-231-3490
Practice Address - Street 1:3224 LAKE WOODARD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3659
Practice Address - Country:US
Practice Address - Phone:919-231-6890
Practice Address - Fax:919-231-3490
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795214Medicaid
NC7702039Medicaid
NC7704336Medicaid
NC0414LOtherBCBS
NC1179580002Medicare NSC
NC0414LOtherBCBS