Provider Demographics
NPI:1285115865
Name:CRANER, CYNTHIA RUTH
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RUTH
Last Name:CRANER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6125
Mailing Address - Country:US
Mailing Address - Phone:614-501-8271
Mailing Address - Fax:614-751-1876
Practice Address - Street 1:4805 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-6125
Practice Address - Country:US
Practice Address - Phone:614-501-8271
Practice Address - Fax:614-751-1876
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2740225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2740Medicaid