Provider Demographics
NPI:1891230017
Name:SEIBERLICH, JOSEPH PAUL (BAS, BCMT, LMT, EMR,)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PAUL
Last Name:SEIBERLICH
Suffix:
Gender:M
Credentials:BAS, BCMT, LMT, EMR,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 MCKENNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5031
Mailing Address - Country:US
Mailing Address - Phone:202-779-0799
Mailing Address - Fax:
Practice Address - Street 1:10212 MCKENNEY AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5031
Practice Address - Country:US
Practice Address - Phone:202-779-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-24
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004030225700000X
MDM05250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist