Healthcare Provider Details

I. General information

NPI: 1780877886
Provider Name (Legal Business Name): DAVID BRIAN TERRY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 ISLAND WALK WAY STE 5
FERNANDINA BEACH FL
32034-1949
US

IV. Provider business mailing address

PO BOX 949
ROME GA
30162-0949
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-4664
  • Fax: 904-261-5852
Mailing address:
  • Phone: 904-261-4664
  • Fax: 904-261-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: