Provider Demographics
NPI:1811948870
Name:SMITH, CYNTHIA S (PT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:S
Last Name:SMITH
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 1:619 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-3203
Mailing Address - Country:US
Mailing Address - Phone:336-563-6568
Mailing Address - Fax:919-304-9042
Practice Address - Street 1:906 MEBANE OAKS RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9780
Practice Address - Country:US
Practice Address - Phone:919-563-1133
Practice Address - Fax:919-304-9042
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211886Medicaid
NCH346512Medicare ID - Type Unspecified