Provider Demographics
NPI:1669404117
Name:STETZER, CHERYL A (PT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:STETZER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S SALISBURY BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5458
Mailing Address - Country:US
Mailing Address - Phone:410-548-7600
Mailing Address - Fax:410-548-2651
Practice Address - Street 1:106 MILFORD ST STE 601
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6938
Practice Address - Country:US
Practice Address - Phone:410-548-7600
Practice Address - Fax:410-548-2651
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD810582810OtherMAMSI
MD402630600Medicaid
MD61138805OtherCAREFIRST BCBS MD
MD810582810OtherOPT CHOICE
MDG5400002OtherBLUECHOICE FEDERAL BCBS
MD810582810OtherAETNA
MD810582810OtherMDIPA
MD524M814FMedicare ID - Type UnspecifiedMEDICARE PROVIDER #