Provider Demographics
NPI:1962614081
Name:FELIX, CYNTHIA ANN (PT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:FELIX
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 1:2127 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2120
Mailing Address - Country:US
Mailing Address - Phone:608-783-0936
Mailing Address - Fax:
Practice Address - Street 1:125 W SIERRA MADRE AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2023
Practice Address - Country:US
Practice Address - Phone:626-812-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61085369225100000X
CAPT296336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40240800Medicaid