MEDICARE: CARLY CUPERNALL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1396628673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY CUPERNALL PT

Provider Business Mailing Address
First Line	:	122 JASONS RDG
Second Line	:
City	:	SMITHSBURG
State	:	MD
Zip	:	21783-1564
Country	:	US
Telephone Number	:	301-302-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	7311 GROVE RD STE H
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-3300
Country	:	US
Telephone Number	:	240-608-6031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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Directions to “ CARLY CUPERNALL PT” Practice Location

Language	Start Address	Practice Location

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