MEDICARE: MR. ROSS TERRY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P13237	NC

General Provider Information

NPI Number	:	1528339058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROSS TERRY PT

Provider Business Mailing Address
First Line	:	4829 CAROLINA BEACH RD STE 100
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 CAROLINA BEACH RD STE 100
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2366
Country	:	US
Telephone Number	:	910-444-0020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	07/29/2020

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