Provider Demographics
NPI:1124174461
Name:BOLTON, CINDY JUNE (MPT)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:JUNE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BRONZE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-7304
Mailing Address - Country:US
Mailing Address - Phone:775-970-5314
Mailing Address - Fax:
Practice Address - Street 1:780 KUENZLI ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1011
Practice Address - Country:US
Practice Address - Phone:775-982-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist