Provider Demographics
NPI:1396628673
Name:CUPERNALL, CARLY (PT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:CUPERNALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 JASONS RDG
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1564
Mailing Address - Country:US
Mailing Address - Phone:301-302-6451
Mailing Address - Fax:
Practice Address - Street 1:7311 GROVE RD STE H
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-3300
Practice Address - Country:US
Practice Address - Phone:240-608-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist