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General NPI Number Information
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NPI Number | 1447702907
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Entity Type | Individual
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Provider Name | JAIMIE FANGMAN PTA
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Gender | Female
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 617 WOODHURST WAY
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City | BALTIMORE
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State | MD
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Zip | 21228-4127
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Country | US
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Telephone | 443-841-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 617 WOODHURST WAY
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City | BALTIMORE
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State | MD
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Zip | 21228-4127
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Country | US
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Telephone | 443-841-2211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A3269
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 9281
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License Number State | MA
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