Healthcare Provider Details

I. General information

NPI: 1174566533
Provider Name (Legal Business Name): NEQUAI T MCLENDON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: NEQUAI TERRY PT

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23379 COMMERCE DR
ACCOMAC VA
23301-1314
US

IV. Provider business mailing address

23379 COMMERCE DR
ACCOMAC VA
23301-1314
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-8284
  • Fax: 757-787-4931
Mailing address:
  • Phone: 757-787-8284
  • Fax: 757-787-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006790
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: