Provider Demographics
NPI:1801939210
Name:TERPSTRA, JENNIFER SUE (ATC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:SUE
Last Name:TERPSTRA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3709 DUBLIN ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1239
Mailing Address - Country:US
Mailing Address - Phone:616-885-4517
Mailing Address - Fax:
Practice Address - Street 1:3825 HENDERSHOT AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-9118
Practice Address - Country:US
Practice Address - Phone:616-784-2400
Practice Address - Fax:616-647-0149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer