Provider Demographics
NPI:1619017381
Name:PUTNAM, JANE ALICE (PT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ALICE
Last Name:PUTNAM
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 1:8107 SHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724
Mailing Address - Country:US
Mailing Address - Phone:301-362-4389
Mailing Address - Fax:
Practice Address - Street 1:14201 LAUREL PARK DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-497-2385
Practice Address - Fax:301-490-7860
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist