Healthcare Provider Details

I. General information

NPI: 1578834768
Provider Name (Legal Business Name): TERRA L STRAIN MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COLLEGE AVE
SILVER CITY NM
88061-0680
US

IV. Provider business mailing address

PO BOX 680 1000 COLLEGE AVE
SILVER CITY NM
88062-0680
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-6236
  • Fax: 575-538-6163
Mailing address:
  • Phone: 575-538-6236
  • Fax: 575-538-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number456
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: