Individual
LAURA TIFFANY MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4337 EBENEZER RD, NOTTINGHAM, MD 21236-2143
(410) 529-3303
Mailing address
209 N LUZERNE AVE, BALTIMORE, MD 21224-1115
(917) 975-1066
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
23349
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F517
BLUE CROSS BLUE SHIELD OF MARYLAND
MD
Enumeration date
05/21/2013
Last updated
05/21/2013
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