Healthcare Provider Details

I. General information

NPI: 1326250895
Provider Name (Legal Business Name): MICHAEL ROBERT JANSEN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MT. HERMON ROAD
SALISBURY MD
21804
US

IV. Provider business mailing address

202 KINSDALE COURT
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7550
  • Fax:
Mailing address:
  • Phone: 410-334-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19274
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: