Provider Demographics
NPI:1134335508
Name:CARMICHAEL, JENNIFER RENEE (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEE
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:BACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5266 FRETER RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9311
Mailing Address - Country:US
Mailing Address - Phone:410-552-6659
Mailing Address - Fax:
Practice Address - Street 1:6190 GEORGETOWN BLVD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6460
Practice Address - Country:US
Practice Address - Phone:410-552-4235
Practice Address - Fax:410-552-4248
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208505OtherMAMSI
MD3401675OtherAETNA HMO
MD7521190OtherAETNA PPO
MD5578OtherHELIX
MD4761-0132OtherCAREFIRST BLUE CHOICE
MD609010-01OtherCAREFIRST BCBS
MD5578OtherHELIX