Provider Demographics
NPI:1730576448
Name:TERRY, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N STEPHANIE ST
Mailing Address - Street 2:1811
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8771
Mailing Address - Country:US
Mailing Address - Phone:702-823-4300
Mailing Address - Fax:
Practice Address - Street 1:375 N STEPHANIE ST
Practice Address - Street 2:1811
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8771
Practice Address - Country:US
Practice Address - Phone:702-823-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2018-10-17
Deactivation Date:2017-10-25
Deactivation Code:
Reactivation Date:2018-10-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner