Provider Demographics
NPI:1063746154
Name:GAYNOR, JEREMY DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DAVID
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 WARREN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2506
Mailing Address - Country:US
Mailing Address - Phone:410-683-9900
Mailing Address - Fax:410-683-3355
Practice Address - Street 1:10 WARREN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2506
Practice Address - Country:US
Practice Address - Phone:410-683-9900
Practice Address - Fax:410-683-3355
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist