Provider Demographics
NPI:1851590202
Name:QUALLS, TIEYA M (PT, DPT, PRPC)
Entity Type:Individual
Prefix:DR
First Name:TIEYA
Middle Name:M
Last Name:QUALLS
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 ELM ST
Mailing Address - Street 2:UNIT 1821
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-7567
Mailing Address - Country:US
Mailing Address - Phone:301-246-2353
Mailing Address - Fax:240-241-6412
Practice Address - Street 1:113 ORONOCO STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2091
Practice Address - Country:US
Practice Address - Phone:301-246-2353
Practice Address - Fax:240-241-6412
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
DCPT870745225100000X
VA23052135232251X0800X
MD21779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No374J00000XNursing Service Related ProvidersDoula
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
927841-02OtherCAREFIRST OF MARYLAND
4695-0031OtherCAREFIRST OF NCA