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NPI Code Detail

MEDICARE: MR. WILLIAM S TERRY DT, CERT MDT

MEDICARE: MR. WILLIAM S TERRY DT, CERT MDT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1203OTHERILBLUE CROSS PROVIDER ID
24117OTHERILHAMP PROVIDER #
37216OTHERILPERSONALCARE PROVIDER ID
4113326OTHERILHEALTHLINK PROVIDER ID

General Provider Information

NPI Number : 1184817843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM S TERRY DT, CERT MDT
Provider Business Mailing Address
First Line : 611 W PARK
Second Line :
City : URBANA
State : IL
Zip : 61801-2500
Country : US
Telephone Number : 217-326-2911
Fax Number : 217-344-8047
Provider Business Practice Location Address
First Line : 610 N LINCOLN AVE
Second Line :
City : URBANA
State : IL
Zip : 61801-2432
Country : US
Telephone Number : 217-329-2911
Fax Number : 217-344-8047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2007
Last Update Date : 08/24/2007

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