Provider Demographics
NPI:1710543046
Name:FERDOUS, JANNATUL (PTA)
Entity Type:Individual
Prefix:
First Name:JANNATUL
Middle Name:
Last Name:FERDOUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1119
Mailing Address - Country:US
Mailing Address - Phone:347-455-4003
Mailing Address - Fax:
Practice Address - Street 1:5330 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7831
Practice Address - Country:US
Practice Address - Phone:410-404-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5139225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant