Provider Demographics
NPI:1851261606
Name:REBLORA, THERESA PETRA JACINTO
Entity type:Individual
Prefix:
First Name:THERESA PETRA
Middle Name:JACINTO
Last Name:REBLORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7549
Mailing Address - Country:US
Mailing Address - Phone:571-315-4534
Mailing Address - Fax:
Practice Address - Street 1:6500 RIGGS RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3056
Practice Address - Country:US
Practice Address - Phone:301-559-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10128225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist