Basic Information
| Provider Information | |||||||||
| NPI: | 1588707186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENTHAL | ||||||||
| FirstName: | TERRANCE | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | A.T., C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | #18 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 N 20TH ST | ||||||||
| Address2: | #18 | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 408 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.