Provider Demographics
NPI:1174971436
Name:SAHM, JENNIFER MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SAHM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11350 EXECUTIVE PLAZA IV RD STE LL12
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8997
Mailing Address - Country:US
Mailing Address - Phone:410-527-1794
Mailing Address - Fax:443-973-6125
Practice Address - Street 1:515 E JOPPA RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-1804
Practice Address - Country:US
Practice Address - Phone:443-841-7027
Practice Address - Fax:443-973-6125
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23887OtherDHMH LICENSE NUMBER