Provider Demographics
NPI:1861719130
Name:TERRY, JAY ANTHONY (LMT, CNMT)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:ANTHONY
Last Name:TERRY
Suffix:
Gender:M
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 THACKER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8664
Mailing Address - Country:US
Mailing Address - Phone:904-716-8342
Mailing Address - Fax:
Practice Address - Street 1:1609 THACKER AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8664
Practice Address - Country:US
Practice Address - Phone:904-716-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA #0021634225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist