Provider Demographics
NPI:1437203247
Name:STURM, THERESA A (MPT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:STURM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7735 ROCTON CT
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3910
Mailing Address - Country:US
Mailing Address - Phone:301-654-0668
Mailing Address - Fax:301-598-7432
Practice Address - Street 1:3836 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1548
Practice Address - Country:US
Practice Address - Phone:301-598-7420
Practice Address - Fax:301-598-7432
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7751010Medicaid
MD338063OtherMAMSI LIFE MD IPA
MDLK24ATOtherCF BLUE CROSS BLUE SHIELD
DCS9860001OtherCF BLUE CROSS BLUE SHIELD
216646Medicare ID - Type Unspecified
DCS9860001OtherCF BLUE CROSS BLUE SHIELD