Provider Demographics
NPI:1104933530
Name:TAYLOR, JENNIFER M (MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 WEST ST
Mailing Address - Street 2:STE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3499
Mailing Address - Country:US
Mailing Address - Phone:410-224-2626
Mailing Address - Fax:410-224-0512
Practice Address - Street 1:901 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2944
Practice Address - Country:US
Practice Address - Phone:410-224-2626
Practice Address - Fax:410-224-0512
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist