Healthcare Provider Details

I. General information

NPI: 1417993411
Provider Name (Legal Business Name): JASON C BAYNARD M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MARVEL CT
EASTON MD
21601-4053
US

IV. Provider business mailing address

401 MARVEL CT
EASTON MD
21601-4053
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-4449
  • Fax:
Mailing address:
  • Phone: 410-820-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0001760
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20794
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: