Provider Demographics
NPI:1023010857
Name:CUGLE, JEREMY WAYNE (MPT)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:WAYNE
Last Name:CUGLE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2448 HOLLY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3148
Mailing Address - Country:US
Mailing Address - Phone:410-295-4941
Mailing Address - Fax:410-295-5207
Practice Address - Street 1:2448 HOLLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3148
Practice Address - Country:US
Practice Address - Phone:410-295-4941
Practice Address - Fax:410-295-5207
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
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MD212822OtherJOHNS HOPKINS HEALTHCARE
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MD2228952OtherFIRST HEALTH NETWORK
MDP00247396OtherRAILROAD MEDICARE
MDT6710010OtherBCBS OF DC
MD618243-05OtherBLUECROSS BLUESHIELD MD
MD624853OtherNATIONAL CAPITAL PPO
MDP00247396OtherRAILROAD MEDICARE
MDT6710010OtherBCBS OF DC