Basic Information
| Provider Information | |||||||||
| NPI: | 1023010857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUGLE | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2448 HOLLY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102954941 | ||||||||
| FaxNumber: | 4102955207 | ||||||||
| Practice Location | |||||||||
| Address1: | 2448 HOLLY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102954941 | ||||||||
| FaxNumber: | 4102955207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20643 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 212822 | 01 | MD | JOHNS HOPKINS HEALTHCARE | OTHER | 6100992 | 01 | MD | MAMSI LIFE & HEALTH | OTHER | 2431344 | 01 | MD | UNITED HEALTHCARE | OTHER | 5536592 | 01 | MD | CCN NETWORK | OTHER | 2228952 | 01 | MD | FIRST HEALTH NETWORK | OTHER | P00247396 | 01 | MD | RAILROAD MEDICARE | OTHER | T6710010 | 01 | MD | BCBS OF DC | OTHER | 618243-05 | 01 | MD | BLUECROSS BLUESHIELD MD | OTHER | 624853 | 01 | MD | NATIONAL CAPITAL PPO | OTHER |