Provider Demographics
NPI:1861450470
Name:KAIDY, TERESA STANLEY
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:STANLEY
Last Name:KAIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15031
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-5031
Mailing Address - Country:US
Mailing Address - Phone:443-860-9168
Mailing Address - Fax:443-636-5987
Practice Address - Street 1:2 E ROLLING XRDS STE 57
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6212
Practice Address - Country:US
Practice Address - Phone:443-860-9168
Practice Address - Fax:443-636-5987
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE705-0005OtherFEDERAL BLUECROSS/SHIELD
MDLV17OtherCAREFIRST BLUECROSS/SHIEL