Healthcare Provider Details

I. General information

NPI: 1356325682
Provider Name (Legal Business Name): DANA TERRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 S 4TH ST
CHICKASHA OK
73018-7502
US

IV. Provider business mailing address

3410 S 4TH ST
CHICKASHA OK
73018-7502
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-9675
  • Fax: 405-224-9677
Mailing address:
  • Phone: 405-224-9675
  • Fax: 405-224-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. DANA DALE TERRY
Title or Position: PRESIDENT
Credential: PT
Phone: 405-224-9675