Provider Demographics
NPI:1093832990
Name:MAHER, JESSICA LYNN (PT, MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:MAHER
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 POPLAR GROVE PL
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2768
Mailing Address - Country:US
Mailing Address - Phone:410-638-0973
Mailing Address - Fax:410-727-2186
Practice Address - Street 1:402 POPLAR GROVE PL
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2768
Practice Address - Country:US
Practice Address - Phone:410-638-0973
Practice Address - Fax:410-727-2186
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD18KBOtherBLUE CROSS BLUE SHIELD
MD7581819OtherAETNA
MD51490001OtherBLUE CHOICE
MD704159OtherUNITED HEALTH CARE