Provider Demographics
NPI:1588706709
Name:ROSENBERG, TERRYL B (PT DPT)
Entity type:Individual
Prefix:DR
First Name:TERRYL
Middle Name:B
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 BETHESDA AVE
Mailing Address - Street 2:417
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5213
Mailing Address - Country:US
Mailing Address - Phone:214-697-2730
Mailing Address - Fax:
Practice Address - Street 1:4710 BETHESDA AVE
Practice Address - Street 2:417
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5213
Practice Address - Country:US
Practice Address - Phone:214-697-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023083225100000X
MD22947225100000X
DCPT8712192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX571156586OtherTAX IDENTIFICATION NUMBER