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General NPI Number Information
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NPI Number | 1497246193
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Entity Type | Organization
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Legal Business Name | KJD
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 8900 COLUMBIA 100 PKWY STE C
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City | COLUMBIA
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State | MD
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Zip | 21045
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Country | US
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Telephone | 408-482-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 8900 COLUMBIA 100 PKWY STE C
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City | COLUMBIA
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State | MD
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Zip | 21045-2336
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KRUPA DARJI
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Credential | PT
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Telephone | 408-482-2186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23927
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License Number State | MD
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