Provider Demographics
NPI:1679642946
Name:RODDA, THERESE ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:ANNE
Last Name:RODDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1352
Mailing Address - Country:US
Mailing Address - Phone:301-922-5018
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-6922
Practice Address - Fax:301-656-6977
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02220F01Medicare ID - Type UnspecifiedMEDICARE PROVIDER #