Provider Demographics
NPI:1811336274
Name:COULSON, JONATHAN (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:COULSON
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 1:3350 WILKENS AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4600
Mailing Address - Country:US
Mailing Address - Phone:410-368-1026
Mailing Address - Fax:410-368-1047
Practice Address - Street 1:3350 WILKENS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4600
Practice Address - Country:US
Practice Address - Phone:410-368-1026
Practice Address - Fax:410-368-1047
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist