Provider Demographics
NPI:1306938006
Name:PATRICK, JENNIFER H (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 TELFORD CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1183
Mailing Address - Country:US
Mailing Address - Phone:410-612-2270
Mailing Address - Fax:
Practice Address - Street 1:4337 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2143
Practice Address - Country:US
Practice Address - Phone:410-529-3303
Practice Address - Fax:410-529-7980
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61033502OtherCAREFIRST OF MD
MD61033501OtherCAREFIRST OF MD
MD3012446OtherAETNA
MDF5170010OtherGHMSI
MD434MN835Medicare ID - Type UnspecifiedTRAILBLAZER