MEDICARE: MS. TERI NOFER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	185123	MD
2	225700000X	Massage Therapist	44946	MD

General Provider Information

NPI Number	:	1619387669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERI NOFER

Provider Business Mailing Address
First Line	:	1738 WEBSTER STREET
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230
Country	:	US
Telephone Number	:	860-682-3470
Fax Number	:

Provider Business Practice Location Address
First Line	:	8894 STANFORD BLVD SUITE 303
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2131
Country	:	US
Telephone Number	:	860-682-3470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	01/14/2020

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