Provider Demographics
NPI:1619529195
Name:FORRESTER, JENNY (DPT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DANBEN CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2426
Mailing Address - Country:US
Mailing Address - Phone:410-707-9498
Mailing Address - Fax:
Practice Address - Street 1:2420 N SALISBURY BLVD UNIT 5
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2189
Practice Address - Country:US
Practice Address - Phone:410-546-4952
Practice Address - Fax:410-546-8358
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027666225100000X
MD22692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist