Provider Demographics
NPI:1306037627
Name:LANDSMAN, JACQUELIN (MPT)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:
Last Name:LANDSMAN
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 1:1109 VOLOS CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-2019
Mailing Address - Country:US
Mailing Address - Phone:410-420-2254
Mailing Address - Fax:
Practice Address - Street 1:UPPER CHESAPEAKE ORTHOPEDICS: CENTER FOR SPORTS MED
Practice Address - Street 2:101 WALTER WARD BLVD
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009
Practice Address - Country:US
Practice Address - Phone:443-643-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist