Provider Demographics
NPI:1093770877
Name:THURLOW, JESSE LB (PT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:LB
Last Name:THURLOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WOODMAR CT
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1348
Mailing Address - Country:US
Mailing Address - Phone:410-592-5092
Mailing Address - Fax:
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:STE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-574-4966
Practice Address - Fax:410-574-4968
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42191502OtherBLUE CROSS B SHIELD
MD0451473OtherAETNA
MD0451473OtherAETNA
MD42191502OtherBLUE CROSS B SHIELD