Provider Demographics
NPI:1437138724
Name:KLINK, JANE ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:KLINK
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 1:2608 MARKER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8302
Mailing Address - Country:US
Mailing Address - Phone:301-371-8464
Mailing Address - Fax:301-662-8762
Practice Address - Street 1:84 THOMAS JOHNSON CT
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-662-8541
Practice Address - Fax:301-662-8762
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD531555-06OtherCAREFIRST MSS
MD531555-05OtherCAREFIRST MD FSS
MDR559-0010OtherCAP FED BC FSS
MD334552OtherPHCS
MD3116439OtherMAMSI MSS
MD551810OtherMAMSI FSS
MDK134-0007OtherCAP FED BC MSS
MD531555-05OtherCAREFIRST MD FSS
MDR559-0010OtherCAP FED BC FSS
MD123MM921Medicare ID - Type UnspecifiedMC FSS