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General NPI Number Information
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NPI Number | 1679469811
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Entity Type | Individual
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Provider Name | JACLYN ELIZABETH PURVIS DPT
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Gender | Female
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 1167 MERRITT BLVD
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City | DUNDALK
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State | MD
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Zip | 21222-1438
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Country | US
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Telephone | 410-282-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HAY MEADOW CT
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City | PERRY HALL
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State | MD
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Zip | 21128-9829
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Country | US
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Telephone | 443-377-5686
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30431
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License Number State | MD
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