Provider Demographics
NPI:1932510765
Name:TARANTULA, ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TARANTULA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5445 LOCH RAVEN BLVD STE 403B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2943
Mailing Address - Country:US
Mailing Address - Phone:443-444-5757
Mailing Address - Fax:443-444-5750
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:O'NEILL BLDG, 2ND FLOOR, OUTPATIENT REHAB
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:443-444-4600
Practice Address - Fax:443-444-4607
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist