Provider Demographics
NPI:1073523395
Name:DONOVAN, JENNIFER KLINE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KLINE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:REBECCA
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 530
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-296-0680
Mailing Address - Fax:410-296-7568
Practice Address - Street 1:515 FAIRMOUNT AVE STE 530
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-296-0680
Practice Address - Fax:410-296-7568
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist