Provider Demographics
NPI:1477540342
Name:ROMAN, JENNIFER LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:41680 MISS BESSIE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2963
Mailing Address - Country:US
Mailing Address - Phone:240-256-3711
Mailing Address - Fax:240-256-3612
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2963
Practice Address - Country:US
Practice Address - Phone:240-256-3711
Practice Address - Fax:240-256-3612
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist