Individual
MRS. CHRISTIE MARIE STACK-SIDES
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.S.PT
Contact information
Practice address
6000 LAUREL BOWIE RD, SUITE 203, BOWIE, MD 20715-4000
(301) 860-0237
(301) 860-0076
Mailing address
3204 ELLIOTT DR, ANNAPOLIS, MD 21403-4669
(410) 224-4520
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
19776
MD
225100000X
Physical Therapist
2305202173
VA
225100000X
Physical Therapist
PT2999
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3324525
AETNA HMO
—
01
—
604729-04
BCBS
MD
01
—
7068079
AETNA PPO
—
Enumeration date
07/19/2005
Last updated
07/08/2007
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