Provider Demographics
NPI:1518965185
Name:STERN, AUDRA RACHEL (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:RACHEL
Last Name:STERN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23 CROSSROADS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5420
Mailing Address - Country:US
Mailing Address - Phone:410-998-9133
Mailing Address - Fax:410-998-9133
Practice Address - Street 1:658 KENILWORTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2312
Practice Address - Country:US
Practice Address - Phone:410-339-4600
Practice Address - Fax:410-339-4601
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD20006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP79186Medicare UPIN
MD345MF211Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER