Provider Demographics
NPI:1679469811
Name:PURVIS, JACLYN ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:PURVIS
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 1:5 HAY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9829
Mailing Address - Country:US
Mailing Address - Phone:443-377-5686
Mailing Address - Fax:
Practice Address - Street 1:1167 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1438
Practice Address - Country:US
Practice Address - Phone:410-282-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist