Provider Demographics
NPI:1184011181
Name:ANKRAH, THERESA T
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:T
Last Name:ANKRAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 UNIVERSITY BLVD W STE 210
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1970
Mailing Address - Country:US
Mailing Address - Phone:240-350-3634
Mailing Address - Fax:
Practice Address - Street 1:344 WEST UNIVERSITY BOULEVARD, SUITE 210
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:240-350-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD#S03770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor