Healthcare Provider Details

I. General information

NPI: 1528191368
Provider Name (Legal Business Name): M JEAN GIOVE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR SUITE M
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

23309 WILDERNESS WALK CT
GAITHERSBURG MD
20882-2733
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-9761
  • Fax: 301-695-8633
Mailing address:
  • Phone: 301-428-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number15642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: