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1972599819

NPI Code Detail

MEDICARE: JAY HERDSON PT

MEDICARE: JAY HERDSON PT

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	2251S0007X	Sports Physical Therapist	19964	MD
2	2251X0800X	Orthopedic Physical Therapist	19964	MD
3	225100000X	Physical Therapist	19964	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	293466	OTHER	MD	MAMSI
3	6545-0007	OTHER	MD	BLUE CHOICE

General Provider Information

NPI Number	:	1972599819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY HERDSON PT

Provider Business Mailing Address
First Line	:	6011 UNIVERSITY BLVD
Second Line	:	SUITE 120
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6074
Country	:	US
Telephone Number	:	410-203-0391
Fax Number	:	410-203-2707

Provider Business Practice Location Address
First Line	:	6011 UNIVERSITY BLVD
Second Line	:	SUITE 120
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6074
Country	:	US
Telephone Number	:	410-203-0391
Fax Number	:	410-203-2707

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	01/18/2024

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Directions to “ JAY HERDSON PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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