Provider Demographics
NPI:1285729343
Name:JESSE L B THURLOW PT
Entity type:Organization
Organization Name:JESSE L B THURLOW PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:L B
Authorized Official - Last Name:THURLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-574-4966
Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4323
Mailing Address - Country:US
Mailing Address - Phone:410-574-4966
Mailing Address - Fax:410-574-4968
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4323
Practice Address - Country:US
Practice Address - Phone:410-574-4966
Practice Address - Fax:410-574-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42191502OtherBCBS MD
MDD481473OtherAETNA
MDJ855Medicare ID - Type Unspecified
MD42191502OtherBCBS MD