Provider Demographics
NPI:1427167931
Name:NUNN, JASON (DPT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:NUNN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-653-9813
Mailing Address - Fax:
Practice Address - Street 1:11200 SCAGGSVILLE RD
Practice Address - Street 2:UNIT 114
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2022
Practice Address - Country:US
Practice Address - Phone:301-317-8373
Practice Address - Fax:301-317-8375
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF8710009OtherCAREFIRST BLUECROSS BLUE SHIELD
MD969LQ216Medicare PIN
DCF8710009OtherCAREFIRST BLUECROSS BLUE SHIELD