Provider Demographics
NPI:1154291854
Name:DAIL, JACLYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:DAIL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 REGATTA BAY CT APT 430
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6680
Mailing Address - Country:US
Mailing Address - Phone:410-693-8338
Mailing Address - Fax:
Practice Address - Street 1:1911 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4118
Practice Address - Country:US
Practice Address - Phone:410-573-1064
Practice Address - Fax:410-573-1065
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty