Basic Information
| Provider Information | |||||||||
| NPI: | 1427167931 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NUNN | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1838 GREENE TREE RD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212086391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106539813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11200 SCAGGSVILLE RD | ||||||||
| Address2: | UNIT 114 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207232022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013178373 | ||||||||
| FaxNumber: | 3013178375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 21596 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | F8710009 | 01 | DC | CAREFIRST BLUECROSS BLUE SHIELD | OTHER |