Provider Demographics
NPI:1801007034
Name:RICHTER, THERESA MARIE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:RICHTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 B AND L CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1382
Mailing Address - Country:US
Mailing Address - Phone:410-439-8588
Mailing Address - Fax:410-439-8588
Practice Address - Street 1:421 BLOOMSBURY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5205
Practice Address - Country:US
Practice Address - Phone:410-887-0808
Practice Address - Fax:410-747-9473
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22OtherATHLETIC TRAINER
MD22Medicaid
MD22Medicare UPIN
MD22Medicare ID - Type UnspecifiedATHLETIC TRAINER