Provider Demographics
NPI:1902923659
Name:ANDERSON, TERRY DAWN (LPTA)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:DAWN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 BLENNERHASSETT HTS
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-8724
Mailing Address - Country:US
Mailing Address - Phone:304-482-0737
Mailing Address - Fax:
Practice Address - Street 1:723 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6022
Practice Address - Country:US
Practice Address - Phone:304-428-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000645225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant