MEDICARE: ANNA TERZANO

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
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1215386537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA TERZANO

Provider Business Mailing Address
First Line	:	2279 DARNELL ST
Second Line	:
City	:	WOLVERINE LAKE
State	:	MI
Zip	:	48390-1845
Country	:	US
Telephone Number	:	248-444-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 MAYFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-3767
Country	:	US
Telephone Number	:	248-444-5805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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Directions to “ ANNA TERZANO ” Practice Location

Language	Start Address	Practice Location

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