Jenna Leigh Glynn, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

28314 Issued in MD

Practice address

23000 Moakley St Ste 102
Leonardtown, MD 20650-2916

Phone

(301) 475-5555

NPI assigned

Jul 27, 2009

Last updated

May 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jenna Leigh Wickham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Frederick, MD
  • NPI 1285068130
  NPD
• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Olney, MD
  • NPI 1487093167
  NPD
• Centers for Advanced Orthopaedics, LLC

  • Orthopaedic Surgery Physician
  • Gainesville, VA
  • NPI 1063393833
  NPD
• Breakthrough Physical Therapy

  • Physical Therapist
  • Morehead City, NC
  • NPI 1083937692
  NPD (past)
• Jacksonville Peak Performance Sports & Physical Therapy, L.L.C.

  • Specialist
  • Jacksonville, NC
  • NPI 1164482402
  NPD (past)
• Peak Performance Sports and Physical Therapy, LLC

  • Physical Therapist
  • New Bern, NC
  • NPI 1194714063
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1184855058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23000 MOAKLEY ST STE 102",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206502916",
            "telephone_number": "301-475-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23000 MOAKLEY ST STE 102",
            "city": "LEONARDTOWN",
            "state": "MD",
            "postal_code": "206502916",
            "telephone_number": "301-475-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLYNN",
        "first_name": "JENNA",
        "middle_name": "LEIGH",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-27",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28314",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "12600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7212810",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "WICKHAM",
            "middle_name": "LEIGH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jasmine Nicole Gentry, MD
• Ruth Diana Gerson, CNM
• Megan Gessford
• Emalie Jean Gibbons Baker, CNM
• Amanda Gibson
• Jackeline Gomez, MD
• Grace by Faith, LLC
• Greater Baden Medical Service Incorporated
• Greater Maryland Pain Management, LLC (Greater Maryland Pain Management)
• Erika Lashawn Greene, ADT

• Physical Therapist in Leonardtown, MD
• Providers in Leonardtown, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.