Healthcare Provider Details

I. General information

NPI: 1609989292
Provider Name (Legal Business Name): TERRESA A FERRUCCIO DOCTORATE OF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 SEWELL MILL RD
MARIETTA GA
30062-4720
US

IV. Provider business mailing address

2856 SEWELL MILL RD
MARIETTA GA
30062-4720
US

V. Phone/Fax

Practice location:
  • Phone: 909-496-9352
  • Fax: 770-726-7546
Mailing address:
  • Phone: 909-496-9352
  • Fax: 770-726-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberPT008742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: