Provider Demographics
NPI:1093761322
Name:BAIKAUSKAS, JENNIFER V (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:V
Last Name:BAIKAUSKAS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NICHOLAS ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:998 HOSPITALITY WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1779
Practice Address - Country:US
Practice Address - Phone:410-273-9776
Practice Address - Fax:410-273-9777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG6140018OtherBS FEP & DC
MD61127103OtherBS MARYLAND