Provider Demographics
NPI:1134149750
Name:TELEMECO, JEFFREY SCOTT (MPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:TELEMECO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WESTERN MARYLAND PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-8168
Mailing Address - Country:US
Mailing Address - Phone:240-452-3205
Mailing Address - Fax:301-665-4576
Practice Address - Street 1:13 WESTERN MARYLAND PKWY STE 204
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-8168
Practice Address - Country:US
Practice Address - Phone:240-452-3205
Practice Address - Fax:301-665-4576
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011706L225100000X
MD21169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008719200001Medicaid
PA1008719200001Medicaid
PA079515SSWMedicare ID - Type Unspecified