Provider Demographics
NPI:1770506248
Name:MEINECKE, TEMMA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TEMMA
Middle Name:
Last Name:MEINECKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 GREENSPRING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4110
Mailing Address - Country:US
Mailing Address - Phone:410-560-3931
Mailing Address - Fax:410-560-0877
Practice Address - Street 1:1920 GREENSPRING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4110
Practice Address - Country:US
Practice Address - Phone:410-560-3931
Practice Address - Fax:410-560-0877
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD685710OtherBCBS MD
MDQ45680Medicare UPIN
MD221ML515Medicare ID - Type Unspecified