Provider Demographics
NPI:1770506248
Name:MEINECKE, TEMMA (MPT)
Entity type:Individual
Prefix:MRS
First Name:TEMMA
Middle Name:
Last Name:MEINECKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 RIDGEBROOK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9440
Mailing Address - Country:US
Mailing Address - Phone:443-212-5745
Mailing Address - Fax:443-212-5749
Practice Address - Street 1:954 RIDGEBROOK RD STE 310
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9440
Practice Address - Country:US
Practice Address - Phone:443-212-5745
Practice Address - Fax:443-212-5749
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD685710OtherBCBS MD
MDQ45680Medicare UPIN
MD221ML515Medicare ID - Type Unspecified