Basic Information
| Provider Information | |||||||||
| NPI: | 1881243699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUARCOOPOME | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | ODARKOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6914 HOLABIRD AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212221747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105902334 | ||||||||
| FaxNumber: | 4105902336 | ||||||||
| Practice Location | |||||||||
| Address1: | 7671 QUARTERFIELD RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210614422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105902334 | ||||||||
| FaxNumber: | 4105902336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2019 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 27595 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.