Provider Demographics
NPI:1669021390
Name:STERLING, JACQUELYN DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:DAWN
Last Name:STERLING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JACQUELYN
Other - Middle Name:DAWN
Other - Last Name:SOKOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:149 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5400
Mailing Address - Country:US
Mailing Address - Phone:443-223-0176
Mailing Address - Fax:
Practice Address - Street 1:7355 E FURNACE BRANCH RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7060
Practice Address - Country:US
Practice Address - Phone:410-766-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
MDA2396225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant