Healthcare Provider Details

I. General information

NPI: 1487626917
Provider Name (Legal Business Name): JILL EDGINGTON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 SOUTHERN MARYLAND BLVD SUITE 103
DUNKIRK MD
20754-3031
US

IV. Provider business mailing address

10020 SOUTHERN MARYLAND BLVD SUITE 103
DUNKIRK MD
20754-3031
US

V. Phone/Fax

Practice location:
  • Phone: 301-855-6326
  • Fax: 301-855-6328
Mailing address:
  • Phone: 301-855-6326
  • Fax: 301-855-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2619
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22456
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: