Healthcare Provider Details

I. General information

NPI: 1457950552
Provider Name (Legal Business Name): TERENCE DOUGLAS FORSS MA, ATC, CAT(C)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10214-104 AVE NW #300
EDMONTON ALBERTA
T6R0M8
CA

IV. Provider business mailing address

4371 MCCLUNG CRESCENT NW
EDMONTON ALBERTA
T6R0M8
CA

V. Phone/Fax

Practice location:
  • Phone: 780-499-7076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000037319
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: