Provider Demographics
NPI:1417993411
Name:BAYNARD, JASON C (MPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:BAYNARD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MARVEL CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4053
Mailing Address - Country:US
Mailing Address - Phone:410-820-4449
Mailing Address - Fax:
Practice Address - Street 1:401 MARVEL CT
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4053
Practice Address - Country:US
Practice Address - Phone:410-820-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001760225100000X
MD20794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61734902OtherCAREFIRST
MD810582810OtherMDIPA
MD402631400Medicaid
MD61734905OtherCAREFIRST BC/BS MD
MD810582810OtherAETNA
MD810582810OtherOPTIMUM CHOICE
MD122042OtherPRIORITY PARTNERS
MDG5400003OtherBLUECHOICE/FEDERAL BC/BS
MD810582810OtherMAMSI
MD61734905OtherCAREFIRST BC/BS MD