Provider Demographics
NPI:1588715718
Name:KRAUSHAAR, CYNTHIA RENAE (PT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:RENAE
Last Name:KRAUSHAAR
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 1:2930 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4302
Mailing Address - Country:US
Mailing Address - Phone:970-259-0563
Mailing Address - Fax:
Practice Address - Street 1:2930 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4302
Practice Address - Country:US
Practice Address - Phone:970-259-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98233866Medicaid