Provider Demographics
NPI:1396047064
Name:BOTTERS, TERRI A (PT)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:A
Last Name:BOTTERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-3238
Mailing Address - Country:US
Mailing Address - Phone:228-822-9066
Mailing Address - Fax:
Practice Address - Street 1:9471 THREE RIVERS RD STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4230
Practice Address - Country:US
Practice Address - Phone:228-822-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist