Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 19278 | MD |
NPI | 1306302088 |
---|---|
Provider Name | Jennifer Powers |
First Address | Forest Hill, MD 21050-2831 |
Second Address | Forest Hill, MD 21050-2831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 18/02/2019 |