Provider Demographics
NPI:1285983767
Name:CYNTHIA OSBORN PHYSICAL THERAPY
Entity type:Organization
Organization Name:CYNTHIA OSBORN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-360-6866
Mailing Address - Street 1:9516 ROUNDLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3969
Mailing Address - Country:US
Mailing Address - Phone:248-360-6866
Mailing Address - Fax:248-360-6866
Practice Address - Street 1:1100 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381
Practice Address - Country:US
Practice Address - Phone:248-360-6866
Practice Address - Fax:248-360-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002197261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3089OtherMEDICARE PTAN
MI650F358050OtherBCBS