Provider Demographics
NPI:1033429113
Name:KISSICK, CYNTHIA JANE (PTA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JANE
Last Name:KISSICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2908
Mailing Address - Country:US
Mailing Address - Phone:816-803-3751
Mailing Address - Fax:
Practice Address - Street 1:909 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2908
Practice Address - Country:US
Practice Address - Phone:816-803-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-05182225200000X
MO2000145659225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant