Provider Demographics
NPI:1346346186
Name:PANDULLO, JODI LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:PANDULLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9284 CHRISTO CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3589
Mailing Address - Country:US
Mailing Address - Phone:410-356-4106
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 302
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-768-1213
Practice Address - Fax:410-768-1203
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD610MK389Medicare ID - Type Unspecified