Provider Demographics
NPI:1205097292
Name:FELICE, JEROD MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:JEROD
Middle Name:MICHAEL
Last Name:FELICE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2982 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1798
Mailing Address - Country:US
Mailing Address - Phone:315-408-8341
Mailing Address - Fax:
Practice Address - Street 1:11270 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1202
Practice Address - Country:US
Practice Address - Phone:315-408-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist