MEDICARE: MRS. BRANDY JENNIFER HARLEY PTA

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	225200000X	Physical Therapy Assistant	A2949	MD

General Provider Information

NPI Number	:	1821428731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDY JENNIFER HARLEY PTA

Provider Business Mailing Address
First Line	:	3441 HOLLAND CLIFFS RD
Second Line	:
City	:	HUNTINGTOWN
State	:	MD
Zip	:	20639-9721
Country	:	US
Telephone Number	:	301-399-4471
Fax Number	:

Provider Business Practice Location Address
First Line	:	11325 PEMBROOKE SQ
Second Line	:	SUITE #115
City	:	WALDORF
State	:	MD
Zip	:	20603-4807
Country	:	US
Telephone Number	:	301-719-1167
Fax Number	:

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

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	11/14/2013

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