Provider Demographics
NPI:1366468175
Name:TALLMAN, LAURA L (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:LIBERATORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2634 BRANDERMILL BLVD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-721-7201
Practice Address - Fax:410-721-7580
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD619265-04OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD80286700Medicaid
MD51200008OtherCAREFIRST
DCF8710005OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD80286700Medicaid