Provider Demographics
NPI:1609989292
Name:FERRUCCIO, TERRESA A (DOCTORATE OF PT)
Entity type:Individual
Prefix:DR
First Name:TERRESA
Middle Name:A
Last Name:FERRUCCIO
Suffix:
Gender:F
Credentials:DOCTORATE OF PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2856 SEWELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4720
Mailing Address - Country:US
Mailing Address - Phone:909-496-9352
Mailing Address - Fax:770-726-7546
Practice Address - Street 1:2856 SEWELL MILL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4720
Practice Address - Country:US
Practice Address - Phone:909-496-9352
Practice Address - Fax:770-726-7546
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008742173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008742OtherPHYSICAL THERAPY LICENSE
NV1932OtherPHYSICAL THERAPY LICENSE
CAPT279940OtherPHYSICAL THERAPY LICENSE
NV1932OtherPHYSICAL THERAPY LICENSE
CAPT279940OtherPHYSICAL THERAPY LICENSE