Individual provider Active NPI

Jennifer Ann Cudzilo, MSPT

  • Physical Therapist
  • Annapolis, MD
National Provider Identifier
1841263654
Registry record updated Oct 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
23174 Issued in MD
Practice address
132 Holiday CT
Suite 203
Annapolis, MD 21401-7005
Phone
(410) 573-9930
Fax
(410) 573-9932
NPI assigned
Feb 10, 2006
Last updated
Oct 9, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 23174 MD Primary

Addresses

Primary practice location

132 Holiday CT
Suite 203
Annapolis, MD 21401-7005

Mailing address

525 Harbor Dr
Annapolis, MD 21403-3760
Phone (410) 573-9930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101213000078 MD Practitioner - Physical Therapist in Private Practice 0143263269 Reassigns benefits to 2 organizations
I20210927001175 DC Practitioner - Physical Therapist in Private Practice 0143263269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Rehab PT MD LLCGroup PAC ID 6709028822, 92 clinicians

Practice addresses (Care Compare)

6451 N Charles St
Baltimore, MD 21212-1010
Phone (877) 407-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23174MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kinetic Physical Therapy, Inc Physical Therapist CurrentSince Oct 18, 2018 Accepting new patients
Fox Rehab PT MD LLC Physical Therapist CurrentSince Sep 1, 2021 Accepting new patients
Fox Rehabilitation Services LLC Physical Therapist CurrentSince Sep 1, 2021 Accepting new patients
Progress Physical Therapy LLC Physical Therapist PastSince Jun 22, 2020 Accepting new patients
Wallace & Nilan Physical Therapy and Fitness, LLC Physical Therapist PastSince May 21, 2011 Accepting new patients
Ft. Washington Rehabilitation & Fitness Center, Inc. Physical Therapist Past Accepting new patients
Shore Movement Physical Therapy, P.a. Physical Therapist PastSince May 8, 2006 Accepting new patients

Locations

132 Holiday Ct
Ste 203
Annapolis, MD 21401
Phone (410) 573-9930

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

7 Carnegie Plz
Cherry Hill, NJ 08003

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1841263654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 HARBOR DR",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214033760",
            "telephone_number": "410-573-9930",
            "fax_number": "410-573-9932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 HOLIDAY CT",
            "address_2": "SUITE 203",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017005",
            "telephone_number": "410-573-9930",
            "fax_number": "410-573-9932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUDZILO",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "23174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.