Provider Demographics
NPI:1992730840
Name:BEHRENDS, CYNTHIA COURI (PT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:COURI
Last Name:BEHRENDS
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 1:200 ACE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-8644
Mailing Address - Country:US
Mailing Address - Phone:815-875-4441
Mailing Address - Fax:815-875-7732
Practice Address - Street 1:200 ACE ROAD
Practice Address - Street 2:STE 2
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356
Practice Address - Country:US
Practice Address - Phone:815-875-4441
Practice Address - Fax:815-875-7732
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14156Medicare ID - Type Unspecified