Provider Demographics
NPI:1053682526
Name:HAMERSLAGH, CYNTHIA L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:HAMERSLAGH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT TECH
Mailing Address - Street 1:405 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1318
Mailing Address - Country:US
Mailing Address - Phone:559-310-2116
Mailing Address - Fax:
Practice Address - Street 1:405 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1318
Practice Address - Country:US
Practice Address - Phone:559-310-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist