Healthcare Provider Details

I. General information

NPI: 1295045441
Provider Name (Legal Business Name): JAMIE HOPKINS P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4664 TYASKIN RD
TYASKIN MD
21865-2000
US

IV. Provider business mailing address

4664 TYASKIN RD
TYASKIN MD
21865-2000
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3521
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: