Provider Demographics
NPI:1215908751
Name:STIFFLER, JEREMY S (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:S
Last Name:STIFFLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E CHURCHVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3844
Mailing Address - Country:US
Mailing Address - Phone:410-638-5525
Mailing Address - Fax:410-638-5558
Practice Address - Street 1:407 E CHURCHVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3844
Practice Address - Country:US
Practice Address - Phone:410-638-5525
Practice Address - Fax:410-638-5558
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28724Medicare UPIN
438MJ936Medicare ID - Type Unspecified