Provider Demographics
NPI:1356783625
Name:HOUCK, JENNIFER (PTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HOUCK
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 1:29770 THREE NOTCH ROAD, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622
Mailing Address - Country:US
Mailing Address - Phone:301-290-0800
Mailing Address - Fax:301-290-1313
Practice Address - Street 1:29770 THREE NOTCH ROAD, SUITE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-0800
Practice Address - Fax:301-290-1313
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist