Healthcare Provider Details

I. General information

NPI: 1881695658
Provider Name (Legal Business Name): JENNIFER KYRITSIS BALDUCCI MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RACHEL KYRITSIS MSPT

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 HOLLY AVE SUITE 200
ANNAPOLIS MD
21401-3148
US

IV. Provider business mailing address

2448 HOLLY AVE SUITE 200
ANNAPOLIS MD
21401-3148
US

V. Phone/Fax

Practice location:
  • Phone: 410-295-4941
  • Fax: 410-295-5207
Mailing address:
  • Phone: 410-295-4941
  • Fax: 410-295-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20158
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: