Basic Information
| Provider Information | |||||||||
| NPI: | 1346451416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERPSTRA | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 SPRINGCREST DR | ||||||||
| Address2: | |||||||||
| City: | FORT MILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297157306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037464655 | ||||||||
| FaxNumber: | 8037467807 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 SPRINGCREST DR | ||||||||
| Address2: | |||||||||
| City: | FORT MILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297157306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037464655 | ||||||||
| FaxNumber: | 8037467807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 32072 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 6687 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 13640 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6687 | 01 | SC | STATE OF SOUTH CAROLINA, DEPARTMENT OF LABOR, LICENSING AND REGULATION | OTHER | 13640 | 01 | NC | NORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS | OTHER | 32072 | 01 | CA | LICENSE | OTHER |