Provider Demographics
NPI:1407007024
Name:JENNINGS, MARIA DITAS VINA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA DITAS
Middle Name:VINA
Last Name:JENNINGS
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 1:117 ORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1309
Mailing Address - Country:US
Mailing Address - Phone:410-686-2270
Mailing Address - Fax:410-686-5447
Practice Address - Street 1:2021A EMMORTON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8962
Practice Address - Country:US
Practice Address - Phone:410-515-0006
Practice Address - Fax:410-515-0027
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist