Provider Demographics
NPI:1275898421
Name:PELLEG, JENNIFER M (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:PELLEG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:BREITHAUPT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5715 OLD BUGGY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2513
Mailing Address - Country:US
Mailing Address - Phone:610-952-8961
Mailing Address - Fax:
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY STE 207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2979
Practice Address - Country:US
Practice Address - Phone:410-884-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0220752251X0800X
MD258022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic