Provider Demographics
NPI:1841263654
Name:CUDZILO, JENNIFER ANN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:CUDZILO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3760
Mailing Address - Country:US
Mailing Address - Phone:410-573-9930
Mailing Address - Fax:410-573-9932
Practice Address - Street 1:132 HOLIDAY CT
Practice Address - Street 2:SUITE 203
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7005
Practice Address - Country:US
Practice Address - Phone:410-573-9930
Practice Address - Fax:410-573-9932
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091215RC4Medicare ID - Type UnspecifiedMEDICARE