Healthcare Provider Details

I. General information

NPI: 1295905677
Provider Name (Legal Business Name): JEMALOU GRAPILON CUYUGAN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST PENINSULA REGIONAL MEDICAL CENTER
SALISBURY MD
21801
US

IV. Provider business mailing address

304 GLEN AVE APT E 1 NORTHPARK GARDENS
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-677-6626
  • Fax:
Mailing address:
  • Phone: 410-603-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22085
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: