Provider Demographics
NPI:1639353097
Name:STIFF, BERTRAM LORING (DPT, MPT)
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:LORING
Last Name:STIFF
Suffix:
Gender:M
Credentials:DPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 APPLE BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2792
Mailing Address - Country:US
Mailing Address - Phone:301-636-9878
Mailing Address - Fax:
Practice Address - Street 1:9801 BROKENLAND PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3080
Practice Address - Country:US
Practice Address - Phone:410-290-6533
Practice Address - Fax:410-290-8646
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist