Provider Demographics
NPI:1851590202
Name:QUALLS, TIEYA M (PT, DPT, PRPC)
Entity type:Individual
Prefix:DR
First Name:TIEYA
Middle Name:M
Last Name:QUALLS
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 ELM ST
Mailing Address - Street 2:UNIT 1821
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-7567
Mailing Address - Country:US
Mailing Address - Phone:301-246-2353
Mailing Address - Fax:240-241-6412
Practice Address - Street 1:113 ORONOCO STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2091
Practice Address - Country:US
Practice Address - Phone:301-246-2353
Practice Address - Fax:240-241-6412
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VA2305213523225100000X
DCPT870745225100000X
MD21779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
4695-0031OtherCAREFIRST OF NCA
927841-02OtherCAREFIRST OF MARYLAND