Healthcare Provider Details

I. General information

NPI: 1841263654
Provider Name (Legal Business Name): JENNIFER ANN CUDZILO MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 HOLIDAY CT SUITE 203
ANNAPOLIS MD
21401-7005
US

IV. Provider business mailing address

525 HARBOR DR
ANNAPOLIS MD
21403-3760
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9930
  • Fax: 410-573-9932
Mailing address:
  • Phone: 410-573-9930
  • Fax: 410-573-9932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23174
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: