Provider Demographics
NPI:1730764044
Name:CRUICKSHANK, TERRY LEROY (PTA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEROY
Last Name:CRUICKSHANK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2744
Mailing Address - Country:US
Mailing Address - Phone:484-744-2205
Mailing Address - Fax:
Practice Address - Street 1:122 SUNNYHILL DR
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1155
Practice Address - Country:US
Practice Address - Phone:215-703-5717
Practice Address - Fax:215-723-2742
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000194225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant