Healthcare Provider Details

I. General information

NPI: 1073370102
Provider Name (Legal Business Name): GEORGE MICHAEL TERRIS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 VISTA WAY STE 106
OCEANSIDE CA
92056-4513
US

IV. Provider business mailing address

3468 SITIO BAYA
CARLSBAD CA
92009-8916
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-2000
  • Fax:
Mailing address:
  • Phone: 760-846-2192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: