Provider Demographics
NPI:1437403219
Name:TRYON, JENNAFER ASHLEY (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNAFER
Middle Name:ASHLEY
Last Name:TRYON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNAFER
Other - Middle Name:ASHLEY
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:314 FRANKLIN AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1263
Mailing Address - Country:US
Mailing Address - Phone:410-641-2900
Mailing Address - Fax:410-641-2914
Practice Address - Street 1:314 FRANKLIN AVE STE 405
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1263
Practice Address - Country:US
Practice Address - Phone:410-641-2900
Practice Address - Fax:410-641-2914
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24279225100000X
DEJ1-0002934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD435138000Medicaid
DE086513OtherMEDICARE
DE0000220726Medicaid
MD216538OtherMEDICARE UNSPEC