MEDICARE: KATHRYN ELIZABETH JENDRAS 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	2251P0200X	Pediatric Physical Therapist	27006	MD

General Provider Information

NPI Number	:	1881155703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ELIZABETH JENDRAS DPT

Provider Business Mailing Address
First Line	:	1708 W ROGERS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4545
Country	:	US
Telephone Number	:	410-578-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 INDUSTRY LN STE 5A
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-1741
Country	:	US
Telephone Number	:	410-367-2222
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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