Provider Demographics
NPI:1154571958
Name:TRONSTAD, CYNTHIA (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TRONSTAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-9733
Mailing Address - Country:US
Mailing Address - Phone:406-775-6256
Mailing Address - Fax:
Practice Address - Street 1:117 BO BO DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2741
Practice Address - Country:US
Practice Address - Phone:601-892-6330
Practice Address - Fax:601-892-6331
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1594225100000X
MSPT6379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist