Provider Demographics
NPI:1699901470
Name:CAPPUCCILLI, JUDITH DAVIS (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:DAVIS
Last Name:CAPPUCCILLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:KAY
Other - Last Name:CAPPUCCILLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3206 OLD LARGO RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7862
Mailing Address - Country:US
Mailing Address - Phone:301-952-0336
Mailing Address - Fax:301-952-0336
Practice Address - Street 1:3206 OLD LARGO RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-7862
Practice Address - Country:US
Practice Address - Phone:301-952-0336
Practice Address - Fax:301-952-0336
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist