Provider Demographics
NPI:1457890485
Name:ALVARADO, TERRY (PTA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:FLANIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1975
Mailing Address - Country:US
Mailing Address - Phone:904-619-5831
Mailing Address - Fax:866-225-4350
Practice Address - Street 1:10660 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1076
Practice Address - Country:US
Practice Address - Phone:904-619-5831
Practice Address - Fax:866-225-4350
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11944224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant