Healthcare Provider Details

I. General information

NPI: 1104625631
Provider Name (Legal Business Name): MISS JAYLA KRISTEN PINKNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 RITCHIE HWY STE 120
PASADENA MD
21122-1069
US

IV. Provider business mailing address

7803 CHERRYBROOK CT
SEVERN MD
21144-3244
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-8750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6136
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: