Individual
JAY HERDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6011 UNIVERSITY BLVD, SUITE 120, ELLICOTT CITY, MD 21043-6074
(410) 203-0391
(410) 203-2707
Mailing address
6011 UNIVERSITY BLVD, SUITE 120, ELLICOTT CITY, MD 21043-6074
(410) 203-0391
(410) 203-2707
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
19964
MD
2251S0007X
Sports Physical Therapist
19964
MD
2251X0800X
Orthopedic Physical Therapist
19964
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075353000
—
MD
01
—
293466
MAMSI
MD
01
—
6545-0007
BLUE CHOICE
MD
Enumeration date
09/26/2005
Last updated
01/18/2024
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