Healthcare Provider Details

I. General information

NPI: 1568577203
Provider Name (Legal Business Name): JENNIFER LYNN FORSBERG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 THOMAS JOHNSON DR STE 100
FREDERICK MD
21702-4314
US

IV. Provider business mailing address

161 THOMAS JOHNSON DR STE 100
FREDERICK MD
21702-4314
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-8311
  • Fax: 240-629-8549
Mailing address:
  • Phone: 301-694-8311
  • Fax: 240-629-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPHYP1560
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28021
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: