Basic Information
| Provider Information | |||||||||
| NPI: | 1417970799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRING | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 844 WASHINGTON RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211576664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108765600 | ||||||||
| FaxNumber: | 4108761623 | ||||||||
| Practice Location | |||||||||
| Address1: | 844 WASHINGTON RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211576664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108765600 | ||||||||
| FaxNumber: | 4108761623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15652 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 197218ZAVL | 01 | MD | MEDICARE PTAN | OTHER | 1219851 60 | 05 | MD | MEDICAID | T208 0115 | 01 | MD | CAREFIRST | OTHER |