Provider Demographics
NPI:1932443447
Name:SMITHERS, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SMITHERS
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 1:205 STONE RUN DR
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2162
Mailing Address - Country:US
Mailing Address - Phone:410-658-2051
Mailing Address - Fax:
Practice Address - Street 1:1881 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2018
Practice Address - Country:US
Practice Address - Phone:410-658-6555
Practice Address - Fax:410-658-9717
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2470225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant