Provider Demographics
NPI:1033976287
Name:CLUBB, CYNTHIA (TRT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CLUBB
Suffix:
Gender:F
Credentials:TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6246 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6600
Mailing Address - Country:US
Mailing Address - Phone:801-969-1420
Mailing Address - Fax:
Practice Address - Street 1:6246 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6600
Practice Address - Country:US
Practice Address - Phone:801-969-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT321593-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist