Provider Demographics
NPI:1992889901
Name:GRANT, JENNIFER (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GRANT
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 1:371 HOMELAND SOUTHWAY
Mailing Address - Street 2:3B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4178
Mailing Address - Country:US
Mailing Address - Phone:443-386-7793
Mailing Address - Fax:
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 236
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-583-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist