Basic Information
| Provider Information | |||||||||
| NPI: | 1750617122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WALTER WARD BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210091285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015921500 | ||||||||
| FaxNumber: | 4433275282 | ||||||||
| Practice Location | |||||||||
| Address1: | 10750 COLUMBIA PIKE STE 401B | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209014457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015921500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18112 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.