Healthcare Provider Details

I. General information

NPI: 1356797773
Provider Name (Legal Business Name): JENNIFER ZANNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CAMPBELL BLVD SUITE 130A
NOTTINGHAM MD
21236-5908
US

IV. Provider business mailing address

4924 CAMPBELL BLVD SUITE 130A
NOTTINGHAM MD
21236-5908
US

V. Phone/Fax

Practice location:
  • Phone: 443-442-2800
  • Fax: 443-442-2808
Mailing address:
  • Phone: 443-442-2800
  • Fax: 443-442-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number19154
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: