Provider Demographics
NPI:1689873762
Name:TERSIS, LLC
Entity Type:Organization
Organization Name:TERSIS, LLC
Other - Org Name:THE WATER'S EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-631-3130
Mailing Address - Street 1:155 SALLITT DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2156
Mailing Address - Country:US
Mailing Address - Phone:410-643-3130
Mailing Address - Fax:410-643-3083
Practice Address - Street 1:155 SALLITT DR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2156
Practice Address - Country:US
Practice Address - Phone:410-643-3130
Practice Address - Fax:410-643-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDOTH000Medicare UPIN
MD160PMedicare PIN