Provider Demographics
NPI:1578834768
Name:STRAIN, TERRA L (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:TERRA
Middle Name:L
Last Name:STRAIN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:1000 COLLEGE AVE
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0680
Mailing Address - Country:US
Mailing Address - Phone:575-538-6236
Mailing Address - Fax:575-538-6163
Practice Address - Street 1:1000 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-0680
Practice Address - Country:US
Practice Address - Phone:575-538-6236
Practice Address - Fax:575-538-6163
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer