Provider Demographics
NPI:1699866723
Name:JENKINS, STACY ANN (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:JENKINS
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 1:6810 SUITLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:MORNINGSIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20746
Mailing Address - Country:US
Mailing Address - Phone:301-758-3685
Mailing Address - Fax:
Practice Address - Street 1:3900 LOCH RAVEN BOULEVARD
Practice Address - Street 2:RM 1A-30
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7589
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist