Provider Demographics
NPI:1053172726
Name:TERHAAR, TRACI (DPT)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:TERHAAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 STONEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-4246
Mailing Address - Country:US
Mailing Address - Phone:970-401-0950
Mailing Address - Fax:
Practice Address - Street 1:3049 STONEYBROOK LN
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-4246
Practice Address - Country:US
Practice Address - Phone:970-401-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL27485225100000X
PAPT032115225100000X
COPTL.0016597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist