Active NPI
Jaimie Fangman, PTA
- Physical Therapy Assistant
- Baltimore, MD
National Provider Identifier
1447702907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 9281
- Practice address
- 617 Woodhurst Way
Baltimore, MD 21228-4127 - Phone
- (443) 841-2211
- NPI assigned
- Nov 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A3269 | MD | |
| Physical Therapy Assistant | 225200000X | 9281 | MA | Primary |
Addresses
Primary practice location
617 Woodhurst Way
Baltimore, MD 21228-4127
Mailing address
617 Woodhurst Way
Baltimore, MD 21228-4127
Phone (443) 841-2211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9281 | MA | MD | Physical Therapy Assistant |
| A3269 | MD | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1447702907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 WOODHURST WAY",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212284127",
"telephone_number": "443-841-2211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 WOODHURST WAY",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212284127",
"telephone_number": "443-841-2211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANGMAN",
"first_name": "JAIMIE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-01",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MD",
"license": "A3269",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "9281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.