Provider Demographics
NPI:1881695658
Name:BALDUCCI, JENNIFER KYRITSIS (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KYRITSIS
Last Name:BALDUCCI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:RACHEL
Other - Last Name:KYRITSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2448 HOLLY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3148
Mailing Address - Country:US
Mailing Address - Phone:410-295-4941
Mailing Address - Fax:410-295-5207
Practice Address - Street 1:2448 HOLLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3148
Practice Address - Country:US
Practice Address - Phone:410-295-4941
Practice Address - Fax:410-295-5207
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5536463OtherCCN NETWORK
MD147433401OtherACS / US DEPT OF LABOR
MDT6710011OtherBCBS OF DC
MDP00247935OtherRAILROAD MEDICARE
MD212821OtherJOHNS HOPKINS HEALTHCARE
MD2228719OtherFIRST HEALTH NETWORK
MD624873OtherNATIONAL CAPITAL PPO
MD609998-08OtherCAREFIRST BCBS
MDT6710011OtherBCBS OF DC
MD624873OtherNATIONAL CAPITAL PPO