Laura L Tallman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

20652 Issued in MD

Practice address

2634 Brandermill Blvd
Gambrills, MD 21054

Phone

(410) 721-7201

Fax

(410) 721-7580

NPI assigned

Jul 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Laura L Liberatore Former name

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Opal Physical Therapy, LLCGroup PAC ID 3375071996, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Opal Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Severna Park, MD
  • NPI 1255173183

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official
• Heynow Senior Therapy, LLC

  • Physical Therapy Clinic/Center
  • Severna Park, MD
  • NPI 1568236065

  Physical Therapist

  Medicare reassignment NPD Authorized official
• Glen Burnie Physical Therapy & Sportscare, LLC

  • Physical Therapist
  • Columbia, MD
  • NPI 1679630073

  DC

  Medicare reassignment NPD
• Professional Sportscare & Rehab, LLC

  • Clinic/Center
  • Winchester, VA
  • NPI 1033142294

  DC, MD, Physical Therapist

  Medicare reassignment NPD
• Opal Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Annapolis, MD
  • NPI 1336010784
  NPD Authorized official
• Glen Burnie Physical Therapy & Sportscare, LLC

  • Physical Therapist
  • Columbia, MD
  • NPI 1417319211
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1366468175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NEW FIDELITY CT",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292665",
            "telephone_number": "919-258-2714",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2634 BRANDERMILL BLVD",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "21054",
            "telephone_number": "410-721-7201",
            "fax_number": "410-721-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLMAN",
        "first_name": "LAURA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "20652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS BLUE SHIELD",
            "identifier": "619265-04",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80286700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "51200008",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS BLUE SHIELD",
            "identifier": "F8710005",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "LIBERATORE",
            "middle_name": "L",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Gambrills, MD
• Providers in Gambrills, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.