Healthcare Provider Details

I. General information

NPI: 1376612705
Provider Name (Legal Business Name): APRIL LYNNE TERRY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 SIXTH AVENUE WEST
KALISPELL MT
59901-1085
US

IV. Provider business mailing address

PO BOX 1085
MARION MT
59925-1085
US

V. Phone/Fax

Practice location:
  • Phone: 406-212-2322
  • Fax:
Mailing address:
  • Phone: 406-212-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number970687
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: