Healthcare Provider Details

I. General information

NPI: 1457280448
Provider Name (Legal Business Name): RIVER TERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3127 VALLEY AVE
WINCHESTER VA
22601-2635
US

IV. Provider business mailing address

129 W WATER ST
MOUNT UNION PA
17066-1274
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: