Provider Demographics
NPI:1699115733
Name:CHOCKLETT, TERISA (PT, DPT)
Entity type:Individual
Prefix:
First Name:TERISA
Middle Name:
Last Name:CHOCKLETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4A MARY JO LN
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4622
Mailing Address - Country:US
Mailing Address - Phone:603-479-7927
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2752
Practice Address - Country:US
Practice Address - Phone:603-685-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist