Provider Demographics
NPI:1962575795
Name:GINDER, CYNTHIA J (PT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:GINDER
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 1:4 TIMBER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-8508
Mailing Address - Country:US
Mailing Address - Phone:309-676-9010
Mailing Address - Fax:309-367-2069
Practice Address - Street 1:114 W STRATFORD DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7301
Practice Address - Country:US
Practice Address - Phone:309-685-2855
Practice Address - Fax:309-685-2844
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70001159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007227878OtherBCBS PROVIDER NUMBER