MEDICARE: MELANIE FAJARDO PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	28609	MD

General Provider Information

NPI Number	:	1780179093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE FAJARDO PT, DPT

Provider Business Mailing Address
First Line	:	326 INGALLS DR
Second Line	:
City	:	MIDDLETOWN
State	:	MD
Zip	:	21769-7973
Country	:	US
Telephone Number	:	301-642-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 MAGNA WAY
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-3073
Country	:	US
Telephone Number	:	443-487-6614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	04/07/2026

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